Provider Demographics
NPI:1790978583
Name:NELIGH CLINIC LLC
Entity Type:Organization
Organization Name:NELIGH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTH-WURDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-887-4681
Mailing Address - Street 1:1108 R ST
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-1022
Mailing Address - Country:US
Mailing Address - Phone:402-887-4681
Mailing Address - Fax:
Practice Address - Street 1:1108 R ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1022
Practice Address - Country:US
Practice Address - Phone:402-887-4681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098661OtherMEDICARE GROUP NUMBER