Provider Demographics
NPI:1326416850
Name:SAUNDERS MEDICAL CENTER
Entity Type:Organization
Organization Name:SAUNDERS MEDICAL CENTER
Other - Org Name:SAUNDERS MEDICAL CENTER LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-443-4191
Mailing Address - Street 1:1760 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4152
Mailing Address - Country:US
Mailing Address - Phone:402-443-4191
Mailing Address - Fax:402-443-1433
Practice Address - Street 1:1760 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4152
Practice Address - Country:US
Practice Address - Phone:402-443-4191
Practice Address - Fax:402-443-1433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAUNDERS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-15
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NE30653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154052OtherPK