Healthcare Provider Details

I. General information

NPI: 1366640591
Provider Name (Legal Business Name): NEBRASKA UROLOGY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 N KANSAS AVE SUITE 201
HASTINGS NE
68901-2615
US

IV. Provider business mailing address

2115 N KANSAS AVE SUITE 201
HASTINGS NE
68901-2615
US

V. Phone/Fax

Practice location:
  • Phone: 402-462-5109
  • Fax:
Mailing address:
  • Phone: 402-462-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number914
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number20214
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12839
License Number StateNE

VIII. Authorized Official

Name: SUE K STROMER
Title or Position: CREDENTIALOR
Credential:
Phone: 402-462-5109