Provider Demographics
NPI:1730113150
Name:BOONE COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:BOONE COUNTY HEALTH CENTER
Other - Org Name:NANCE COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-395-3213
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-0151
Mailing Address - Country:US
Mailing Address - Phone:402-395-3213
Mailing Address - Fax:402-395-3173
Practice Address - Street 1:405 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3155
Practice Address - Country:US
Practice Address - Phone:308-536-2446
Practice Address - Fax:308-536-2727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONE COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========19Medicaid
NE=========19Medicaid