Provider Demographics
NPI:1376885921
Name:NEBRASKA MEDICAL MART II INC
Entity Type:Organization
Organization Name:NEBRASKA MEDICAL MART II INC
Other - Org Name:NEBRASKA MEDICAL MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING REP
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KLANECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-727-4270
Mailing Address - Street 1:1451 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-3534
Mailing Address - Country:US
Mailing Address - Phone:402-727-4270
Mailing Address - Fax:402-727-7682
Practice Address - Street 1:115 E 6TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-2917
Practice Address - Country:US
Practice Address - Phone:800-633-6323
Practice Address - Fax:402-727-7682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEBRASKA MEDICAL MART II INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE001011468033332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies