Provider Demographics
NPI:1265975460
Name:COMPER CARE OUTPATIENT CENTER INC
Entity type:Organization
Organization Name:COMPER CARE OUTPATIENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-298-4555
Mailing Address - Street 1:205 S 23RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2900
Mailing Address - Country:US
Mailing Address - Phone:402-298-4555
Mailing Address - Fax:402-298-4123
Practice Address - Street 1:205 S 23RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2900
Practice Address - Country:US
Practice Address - Phone:402-298-4555
Practice Address - Fax:402-298-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1487013306Medicaid
NE1487013306Medicare UPIN
NE1487013306Medicare Oscar/Certification
NE1487013306Medicare NSC
NE1487013306Medicaid