Provider Demographics
NPI:1639242621
Name:W.V. FATTIG M.D.
Entity Type:Organization
Organization Name:W.V. FATTIG M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTIG
Authorized Official - Suffix:
Authorized Official - Credentials:CO-OWNER
Authorized Official - Phone:308-225-4498
Mailing Address - Street 1:723 FLACK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3514
Mailing Address - Country:US
Mailing Address - Phone:308-225-4498
Mailing Address - Fax:308-646-0341
Practice Address - Street 1:723 FLACK AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3514
Practice Address - Country:US
Practice Address - Phone:308-225-4498
Practice Address - Fax:308-646-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21201261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE21201OtherSTATE LICENSE
NE28D1030805OtherCLIA
NE507843624OtherSS#
NEP00181202OtherRR MEDICARE
NE04137OtherBCBS
NE10025150600Medicaid
NE35808OtherMIDLANDS CHOICE
NE35808OtherMIDLANDS CHOICE
NE10025150600Medicaid