Provider Demographics
NPI:1891321790
Name:CAWAB MEDICAL LLC
Entity Type:Organization
Organization Name:CAWAB MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBELRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-889-3633
Mailing Address - Street 1:18021 OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6035
Mailing Address - Country:US
Mailing Address - Phone:402-889-3633
Mailing Address - Fax:531-375-3755
Practice Address - Street 1:18021 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6035
Practice Address - Country:US
Practice Address - Phone:402-889-3633
Practice Address - Fax:531-375-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1124062161Medicaid