Provider Demographics
NPI:1467529727
Name:NEBRASKA MEDICAL CENTER
Entity Type:Organization
Organization Name:NEBRASKA MEDICAL CENTER
Other - Org Name:THE NEBRASKA MEDICAL CENTER BELLEVUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICIER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-552-2889
Mailing Address - Street 1:2510 BELLEVUE MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-595-1156
Mailing Address - Fax:402-595-1029
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-595-1156
Practice Address - Fax:402-595-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23383336C0002X
NE28743336C0003X
IA39403336C0003X
SD400-17623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE911858733-01Medicaid
NE91185843301Medicaid