Provider Demographics
NPI:1407409261
Name:MIDTOWN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MIDTOWN HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS AUDITOR/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MELODEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRENKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-370-1064
Mailing Address - Street 1:302 W PHILLIP AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5248
Mailing Address - Country:US
Mailing Address - Phone:402-371-8000
Mailing Address - Fax:402-371-0971
Practice Address - Street 1:611 MEADOW LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-7215
Practice Address - Country:US
Practice Address - Phone:402-371-8000
Practice Address - Fax:402-371-0971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDTOWN HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-22
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)