Provider Demographics
NPI:1467442244
Name:SAUNDERS MEDICAL CENTER
Entity Type:Organization
Organization Name:SAUNDERS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-443-4191
Mailing Address - Street 1:1760 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4152
Mailing Address - Country:US
Mailing Address - Phone:402-443-4191
Mailing Address - Fax:402-443-1433
Practice Address - Street 1:1760 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4152
Practice Address - Country:US
Practice Address - Phone:402-443-4191
Practice Address - Fax:402-443-1433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAUNDERS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07664OtherBLUE CROS BLUE SHIELD
NE=========13Medicaid
NE=========19Medicaid
NE07664OtherBLUE CROS BLUE SHIELD
NE=========13Medicaid
NE283990Medicare Oscar/Certification
NE092301Medicare PIN