Healthcare Provider Details

I. General information

NPI: 1134236060
Provider Name (Legal Business Name): COLUMBUS FAMILY PRACTICE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 38 ST
COLUMBUS NE
68601-1616
US

IV. Provider business mailing address

4214 38 ST.
COLUMBUS NE
68601-1616
US

V. Phone/Fax

Practice location:
  • Phone: 402-564-1338
  • Fax: 402-564-8902
Mailing address:
  • Phone: 402-564-1338
  • Fax: 402-564-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELSEY JARESKE
Title or Position: CREDENTIALER
Credential:
Phone: 402-564-1338