Provider Demographics
NPI:1710023288
Name:ANNIE JEFFREY MEMORIAL COUNTY HEALTH
Entity Type:Organization
Organization Name:ANNIE JEFFREY MEMORIAL COUNTY HEALTH
Other - Org Name:ANNIE JEFFREY MEM CNTY HSP PHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIN
Authorized Official - Suffix:
Authorized Official - Credentials:R P
Authorized Official - Phone:308-940-2592
Mailing Address - Street 1:531 BEEBE ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:NE
Mailing Address - Zip Code:68651-5537
Mailing Address - Country:US
Mailing Address - Phone:402-747-2031
Mailing Address - Fax:402-747-1405
Practice Address - Street 1:531 BEEBE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:NE
Practice Address - Zip Code:68651-5537
Practice Address - Country:US
Practice Address - Phone:402-747-2031
Practice Address - Fax:402-747-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6400013336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2811354OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NE=========00Medicaid