Provider Demographics
NPI:1386833804
Name:BOONE COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:BOONE COUNTY HEALTH CENTER
Other - Org Name:BOONE COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:K
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-395-3213
Mailing Address - Street 1:723 W FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-1725
Mailing Address - Country:US
Mailing Address - Phone:402-395-2191
Mailing Address - Fax:402-395-3168
Practice Address - Street 1:723 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1725
Practice Address - Country:US
Practice Address - Phone:402-395-2191
Practice Address - Fax:402-395-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25573336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE281334Medicaid
2811378OtherNCPDP PROVIDER IDENTIFICATION NUMBER
=========0Medicare NSC