Provider Demographics
NPI:1730978297
Name:SAUDER, TABBOTT JOHN SR
Entity type:Individual
Prefix:MR
First Name:TABBOTT
Middle Name:JOHN
Last Name:SAUDER
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160065 OUDERKIRK DR
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-7311
Mailing Address - Country:US
Mailing Address - Phone:308-641-5267
Mailing Address - Fax:
Practice Address - Street 1:11011 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3700
Practice Address - Country:US
Practice Address - Phone:308-641-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty