Provider Demographics
NPI:1659652600
Name:PROMEDCARE INC
Entity Type:Organization
Organization Name:PROMEDCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VP
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-727-7900
Mailing Address - Street 1:426 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2633
Mailing Address - Country:US
Mailing Address - Phone:402-727-7900
Mailing Address - Fax:402-727-7904
Practice Address - Street 1:426 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2633
Practice Address - Country:US
Practice Address - Phone:402-727-7900
Practice Address - Fax:402-727-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-05
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE001-011062916332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11689277Medicaid
NE11689277Medicaid