Healthcare Provider Details

I. General information

NPI: 1770033912
Provider Name (Legal Business Name): BLUESTEM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST STE 435
LINCOLN NE
68502-3796
US

IV. Provider business mailing address

1021 N 27TH ST
LINCOLN NE
68503-1803
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-7445
  • Fax: 402-476-1670
Mailing address:
  • Phone: 402-476-1455
  • Fax: 402-476-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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