Provider Demographics
NPI:1437111408
Name:CANCER PARTNERS OF NEBRASKA PC
Entity Type:Organization
Organization Name:CANCER PARTNERS OF NEBRASKA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-420-7000
Mailing Address - Street 1:4101 TIGER LILY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5587
Mailing Address - Country:US
Mailing Address - Phone:402-420-7000
Mailing Address - Fax:402-420-6969
Practice Address - Street 1:4101 TIGER LILY RD STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5587
Practice Address - Country:US
Practice Address - Phone:402-420-7000
Practice Address - Fax:402-420-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07617OtherBCBS NE
NE3600481OtherUNITED HEALTHCARE
NECI6805OtherRR MEDICARE
MO506139609Medicaid
MO506139609Medicaid
KS111087Medicare PIN
NECI6805OtherRR MEDICARE
NE1310070002Medicare NSC
NE098708Medicare PIN
NE098706Medicare PIN