Provider Demographics
NPI:1700115987
Name:WAHOO MEDICAL P.C.
Entity Type:Organization
Organization Name:WAHOO MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-443-4600
Mailing Address - Street 1:567 W 15TH ST
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1280
Mailing Address - Country:US
Mailing Address - Phone:402-443-4600
Mailing Address - Fax:402-443-4660
Practice Address - Street 1:567 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1280
Practice Address - Country:US
Practice Address - Phone:402-443-4600
Practice Address - Fax:402-443-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336347616OtherNPI #
1336347616OtherNPI #
NES15686Medicare UPIN
NEP81148Medicare UPIN
NEG98758Medicare UPIN