Provider Demographics
NPI:1740516764
Name:MIDTOWN HEALTH CENTER, INC.
Entity type:Organization
Organization Name:MIDTOWN HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-370-1060
Mailing Address - Street 1:302 W PHILLIP AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5248
Mailing Address - Country:US
Mailing Address - Phone:402-371-8000
Mailing Address - Fax:402-371-0971
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:BOX 454
Practice Address - City:MADISON
Practice Address - State:NE
Practice Address - Zip Code:68748-6485
Practice Address - Country:US
Practice Address - Phone:402-454-3304
Practice Address - Fax:402-454-2567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDTOWN HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHC050101YM0800X, 261QC1500X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025716900OtherMEDICAID FQHC
NE10025716400Medicaid
NE10025716900OtherMEDICAID FQHC
NE099495Medicare PIN