Provider Demographics
NPI:1457887218
Name:FAMILY MEDICINE AND URGENT CARE OF WAVERLY, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE AND URGENT CARE OF WAVERLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-786-7425
Mailing Address - Street 1:13851 GUILDFORD ST STE D
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-1453
Mailing Address - Country:US
Mailing Address - Phone:402-786-7425
Mailing Address - Fax:402-786-7427
Practice Address - Street 1:13851 GUILDFORD ST STE D
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1453
Practice Address - Country:US
Practice Address - Phone:402-786-7425
Practice Address - Fax:402-786-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty