Provider Demographics
NPI:1962863126
Name:SOUTHEAST DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:SOUTHEAST DISTRICT HEALTH DEPARTMENT
Other - Org Name:SOUTHEAST DISTRICT HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUEGGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:402-274-3993
Mailing Address - Street 1:2511 SCHNEIDER AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-3054
Mailing Address - Country:US
Mailing Address - Phone:402-274-3993
Mailing Address - Fax:402-274-3967
Practice Address - Street 1:2511 SCHNEIDER AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-3054
Practice Address - Country:US
Practice Address - Phone:402-274-3993
Practice Address - Fax:402-274-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026567600Medicaid