Provider Demographics
NPI:1821283896
Name:DONALD C WELDON
Entity Type:Organization
Organization Name:DONALD C WELDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-228-3545
Mailing Address - Street 1:1201 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2003
Mailing Address - Country:US
Mailing Address - Phone:402-228-3545
Mailing Address - Fax:402-228-3826
Practice Address - Street 1:1201 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2003
Practice Address - Country:US
Practice Address - Phone:402-228-3545
Practice Address - Fax:402-228-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16679207R00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00733OtherBLUE CROSS BLUE SHIELD
NE00733OtherBLUE CROSS BLUE SHIELD
NE00733OtherBLUE CROSS BLUE SHIELD
NE092579Medicare PIN
NEB90875Medicare UPIN