Provider Demographics
NPI:1144556333
Name:NEBRASKA PEDIATRIC PRACTICE, INC
Entity type:Organization
Organization Name:NEBRASKA PEDIATRIC PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-955-6795
Mailing Address - Street 1:8200 DODGE ST
Mailing Address - Street 2:NEBRASKA PEDIATRIC PRACTICE, INC
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-6795
Mailing Address - Fax:402-955-4100
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:NEBRASKA PEDIATRIC PRACTICE, INC
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-6795
Practice Address - Fax:402-955-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty