Provider Demographics
NPI:1447206412
Name:FREMONT MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:FREMONT MEDICAL ASSOCIATES, P.C.
Other - Org Name:HEALTHCARE FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KEASLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-721-3133
Mailing Address - Street 1:700 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2384
Mailing Address - Country:US
Mailing Address - Phone:402-721-3133
Mailing Address - Fax:402-941-7017
Practice Address - Street 1:700 E 29TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2384
Practice Address - Country:US
Practice Address - Phone:402-721-3133
Practice Address - Fax:402-941-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========16Medicaid
NE092157Medicare ID - Type UnspecifiedDIVISION MEDICARE NUMBER