Provider Demographics
NPI:1942368352
Name:NEBRASKA MEDICAL CENTER
Entity Type:Organization
Organization Name:NEBRASKA MEDICAL CENTER
Other - Org Name:THE NEBRASKA MEDICAL CENTER CLINIC PHARMACY - 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:P.O BOX 3839
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0839
Mailing Address - Country:US
Mailing Address - Phone:402-552-2040
Mailing Address - Fax:402-552-2152
Practice Address - Street 1:989200 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-9200
Practice Address - Country:US
Practice Address - Phone:402-559-5106
Practice Address - Fax:402-559-7150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEBRASKA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1295450001Medicare NSC
NE280013Medicare ID - Type UnspecifiedMAIN CLINIC PHARMACY