Provider Demographics
NPI:1356328710
Name:NEBRASKA BRACE & LIMB CO
Entity Type:Organization
Organization Name:NEBRASKA BRACE & LIMB CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:SR
Authorized Official - Credentials:BOCO CO
Authorized Official - Phone:308-234-5959
Mailing Address - Street 1:104 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-6035
Mailing Address - Country:US
Mailing Address - Phone:308-234-5959
Mailing Address - Fax:308-234-4359
Practice Address - Street 1:104 W 16TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-6035
Practice Address - Country:US
Practice Address - Phone:308-234-5959
Practice Address - Fax:308-234-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
0290840001Medicare ID - Type Unspecified