Provider Demographics
NPI:1922522986
Name:AMY METSCHKE
Entity Type:Organization
Organization Name:AMY METSCHKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LADC
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:METSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-646-0103
Mailing Address - Street 1:2979 LITTLE SALT RD
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-7803
Mailing Address - Country:US
Mailing Address - Phone:402-646-2240
Mailing Address - Fax:
Practice Address - Street 1:128 N 6TH ST STE F
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2072
Practice Address - Country:US
Practice Address - Phone:402-646-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder