Provider Demographics
NPI:1831369347
Name:OBERMIER, RANDY SCOTT (CPED)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:SCOTT
Last Name:OBERMIER
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-3039
Mailing Address - Country:US
Mailing Address - Phone:402-362-5063
Mailing Address - Fax:
Practice Address - Street 1:514 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-3039
Practice Address - Country:US
Practice Address - Phone:402-362-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5613380001Medicare NSC