Provider Demographics
NPI:1639364342
Name:JOHN F CORDOVA MD PC
Entity Type:Organization
Organization Name:JOHN F CORDOVA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAALII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-475-9090
Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502
Mailing Address - Country:US
Mailing Address - Phone:402-475-9090
Mailing Address - Fax:402-475-9092
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-475-9090
Practice Address - Fax:402-475-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty