Healthcare Provider Details

I. General information

NPI: 1861940264
Provider Name (Legal Business Name): INTEGRATED PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 10/13/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 W 3RD ST
HASTINGS NE
68901-5134
US

IV. Provider business mailing address

PO BOX 261
HASTINGS NE
68902-0261
US

V. Phone/Fax

Practice location:
  • Phone: 402-834-2438
  • Fax:
Mailing address:
  • Phone: 402-834-2438
  • Fax: 402-834-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHY KLEIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-834-2438