Healthcare Provider Details

I. General information

NPI: 1437773777
Provider Name (Legal Business Name): GREATER NEBRASKA INFUSION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 SAINT PATRICK AVE STE 6
GRAND ISLAND NE
68803-1313
US

IV. Provider business mailing address

2604 SAINT PATRICK AVE STE 6
GRAND ISLAND NE
68803-1313
US

V. Phone/Fax

Practice location:
  • Phone: 308-675-7016
  • Fax: 308-675-7017
Mailing address:
  • Phone: 308-675-7016
  • Fax: 308-675-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JERRY LOBEDA
Title or Position: PRESIDENT
Credential:
Phone: 308-675-7016