Healthcare Provider Details

I. General information

NPI: 1063558864
Provider Name (Legal Business Name): NEBCO ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E ELWOOD ST
PHOENIX AZ
85040-1610
US

IV. Provider business mailing address

16 HAWK RIDGE CIR
LAKE ST LOUIS MO
63367-1861
US

V. Phone/Fax

Practice location:
  • Phone: 602-296-6542
  • Fax: 602-437-2594
Mailing address:
  • Phone: 480-966-8377
  • Fax: 480-736-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: ALAINA MACIA
Title or Position: MANAGER
Credential:
Phone: 636-561-5686