Healthcare Provider Details

I. General information

NPI: 1043526080
Provider Name (Legal Business Name): FREMONT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 EAST 22ND STREET SUITE 100
FREMONT NE
68025-2633
US

IV. Provider business mailing address

426 E 22ND STREET SUITE 100
FREMONT NE
68025-2633
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-7796
  • Fax: 402-727-9574
Mailing address:
  • Phone: 402-727-7796
  • Fax: 402-727-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK M BOOTH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 402-721-1610