Provider Demographics
NPI:1598767287
Name:ELKHORN VALLEY FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:ELKHORN VALLEY FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-4222
Mailing Address - Street 1:304 E DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1830
Mailing Address - Country:US
Mailing Address - Phone:402-336-4222
Mailing Address - Fax:402-336-4228
Practice Address - Street 1:304 E DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1830
Practice Address - Country:US
Practice Address - Phone:402-336-4222
Practice Address - Fax:402-336-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025080400Medicaid
NE10025080400Medicaid
NE5126400001Medicare NSC