Healthcare Provider Details

I. General information

NPI: 1376189506
Provider Name (Legal Business Name): FREMONT HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 23RD ST
FREMONT NE
68025-2592
US

IV. Provider business mailing address

2540 N HEALTHY WAY
FREMONT NE
68025-2315
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-7077
  • Fax:
Mailing address:
  • Phone: 402-727-1091
  • Fax: 402-727-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT M RICHMOND
Title or Position: PRESIDENT
Credential:
Phone: 402-727-1610