MEDICARE: NEBRASKA KIDNEY HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1184272577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEBRASKA KIDNEY HEALTH PC

Provider Business Mailing Address
First Line	:	3601 LAKE PARK LN
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-2581
Country	:	US
Telephone Number	:	402-984-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N SAINT JOSEPH AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-2652
Country	:	US
Telephone Number	:	402-463-4893
Fax Number	:	402-463-7049

Authorized Official
Title or Position	:	OWNER
Name	:	RAMEZ HABASH
Credential	:
Telephone Number	:	402-984-9696

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	08/28/2019

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