Provider Demographics
NPI:1497938542
Name:WINNEBAGO TRIBE OF NEBRASKA
Entity type:Organization
Organization Name:WINNEBAGO TRIBE OF NEBRASKA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEWEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-745-3950
Mailing Address - Street 1:225 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071
Mailing Address - Country:US
Mailing Address - Phone:402-745-3650
Mailing Address - Fax:402-878-2237
Practice Address - Street 1:225 BLUFF ST
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-745-3650
Practice Address - Fax:402-878-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========25Medicaid