Healthcare Provider Details

I. General information

NPI: 1487089611
Provider Name (Legal Business Name): HARLAN MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 HARLAN DR
BELLEVUE NE
68005-3699
US

IV. Provider business mailing address

1307 HARLAN DR
BELLEVUE NE
68005-3699
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-8701
  • Fax:
Mailing address:
  • Phone: 402-291-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number1447
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number22162
License Number StateNE

VIII. Authorized Official

Name: MICHELLE R MERTZ
Title or Position: OWNER
Credential:
Phone: 402-291-8701