Healthcare Provider Details

I. General information

NPI: 1932156114
Provider Name (Legal Business Name): BLUESTEM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 N 27TH ST
LINCOLN NE
68503-1803
US

IV. Provider business mailing address

1021 N 27TH ST
LINCOLN NE
68503-1803
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-1455
  • Fax: 402-476-1670
Mailing address:
  • Phone: 402-476-1455
  • Fax: 402-476-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberHC039
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BRAD LEE MEYER
Title or Position: CEO
Credential:
Phone: 402-470-5424