Healthcare Provider Details

I. General information

NPI: 1639248560
Provider Name (Legal Business Name): TWIN RIVERS URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N WEBB RD
GRAND ISLAND NE
68803-3310
US

IV. Provider business mailing address

720 N WEBB RD
GRAND ISLAND NE
68803-3310
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-2500
  • Fax: 308-384-2565
Mailing address:
  • Phone: 308-384-2500
  • Fax: 308-842-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20673
License Number StateNE

VIII. Authorized Official

Name: BRYAN DAVID NOKELBY
Title or Position: MD CEO
Credential: MD
Phone: 308-384-2500