Provider Demographics
NPI:1619279312
Name:UROLOGY CANCER CENTER PC
Entity Type:Organization
Organization Name:UROLOGY CANCER CENTER PC
Other - Org Name:XCANCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NORDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-991-8468
Mailing Address - Street 1:17607 GOLD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-5606
Mailing Address - Country:US
Mailing Address - Phone:402-991-8468
Mailing Address - Fax:402-991-8469
Practice Address - Street 1:17607 GOLD PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-5606
Practice Address - Country:US
Practice Address - Phone:402-991-8468
Practice Address - Fax:402-991-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025921600Medicaid
NENA1775Medicare PIN
NENA1776Medicare PIN