Provider Demographics
NPI:1669407821
Name:BOONE COUNTY HEALTH CENTER
Entity type:Organization
Organization Name:BOONE COUNTY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:K
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-395-3213
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-0151
Mailing Address - Country:US
Mailing Address - Phone:402-395-3213
Mailing Address - Fax:402-395-3173
Practice Address - Street 1:723 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1767
Practice Address - Country:US
Practice Address - Phone:402-395-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONE COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2927OtherBCBS OF NEBRASKA
NE8557OtherBCBS OF NEBRASKA
NE=========08Medicaid
NE=========09Medicaid
NE=========13Medicaid
NE2927OtherBCBS OF NEBRASKA
NE8557OtherBCBS OF NEBRASKA
NE=========10Medicaid
NE=========20Medicaid
NE=========09Medicaid