Provider Demographics
NPI:1386627909
Name:FREMONT MEDICAL ASSOCIATES - INTERNAL MEDICINE
Entity Type:Organization
Organization Name:FREMONT MEDICAL ASSOCIATES - INTERNAL MEDICINE
Other - Org Name:FREMONT INTERNAL MEDICINE COMPLETE ADULT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-727-5200
Mailing Address - Street 1:680 E FREMONT MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2039
Mailing Address - Country:US
Mailing Address - Phone:402-727-5200
Mailing Address - Fax:402-721-5230
Practice Address - Street 1:680 E FREMONT MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2039
Practice Address - Country:US
Practice Address - Phone:402-727-5200
Practice Address - Fax:402-721-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========12Medicaid
NE096632Medicare PIN