Provider Demographics
NPI:1568968543
Name:FAMILY MEDICINE AND URGENT CARE OF GRAND ISLAND LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE AND URGENT CARE OF GRAND ISLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:NAHRSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRNC
Authorized Official - Phone:308-675-3900
Mailing Address - Street 1:423 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-4503
Mailing Address - Country:US
Mailing Address - Phone:308-675-3900
Mailing Address - Fax:308-675-3899
Practice Address - Street 1:423 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4503
Practice Address - Country:US
Practice Address - Phone:308-675-3900
Practice Address - Fax:308-675-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty