Provider Demographics
NPI:1891721395
Name:NEBRASKA MEDICAL CENTER
Entity Type:Organization
Organization Name:NEBRASKA MEDICAL CENTER
Other - Org Name:CLARKSON FAMILY MEDICINE - NEBRASKA MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-552-2889
Mailing Address - Street 1:4200 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2705
Mailing Address - Country:US
Mailing Address - Phone:402-552-3222
Mailing Address - Fax:402-552-2172
Practice Address - Street 1:4200 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2705
Practice Address - Country:US
Practice Address - Phone:402-552-3222
Practice Address - Fax:402-552-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE98652Medicare PIN