Provider Demographics
NPI:1639248560
Name:TWIN RIVERS URGENT CARE LLC
Entity type:Organization
Organization Name:TWIN RIVERS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NOKELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-384-2500
Mailing Address - Street 1:720 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3310
Mailing Address - Country:US
Mailing Address - Phone:308-384-2500
Mailing Address - Fax:308-842-5653
Practice Address - Street 1:720 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3310
Practice Address - Country:US
Practice Address - Phone:308-384-2500
Practice Address - Fax:308-384-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025335000Medicaid
NE099796Medicare ID - Type Unspecified