MEDICARE: NORTHEAST NEBRASKA PAIN MEDICINE LLC

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	208VP0000X	Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417257403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST NEBRASKA PAIN MEDICINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 5126
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5126
Country	:	US
Telephone Number	:	605-335-1952
Fax Number	:	605-373-9971

Provider Business Practice Location Address
First Line	:	1414 N 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-316-4027
Fax Number	:	402-316-3469

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER E PRICE
Credential	:	MD
Telephone Number	:	402-644-7506

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	12/10/2015

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