Healthcare Provider Details

I. General information

NPI: 1740280437
Provider Name (Legal Business Name): KISMET FNB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 TOWLE ST
FALLS CITY NE
68355-1065
US

IV. Provider business mailing address

2800 TOWLE ST
FALLS CITY NE
68355-1065
US

V. Phone/Fax

Practice location:
  • Phone: 402-245-5252
  • Fax: 402-245-2592
Mailing address:
  • Phone: 402-245-5252
  • Fax: 402-245-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number664001
License Number StateNE

VIII. Authorized Official

Name: MICHAEL L. MOORE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 605-642-7736