Healthcare Provider Details

I. General information

NPI: 1740516764
Provider Name (Legal Business Name): MIDTOWN HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MAIN ST BOX 454
MADISON NE
68748-6485
US

IV. Provider business mailing address

302 W PHILLIP AVE
NORFOLK NE
68701-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-454-3304
  • Fax: 402-454-2567
Mailing address:
  • Phone: 402-371-8000
  • Fax: 402-371-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberHC050
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberHC050
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberHC050
License Number StateNE

VIII. Authorized Official

Name: KATHY NORDBY
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential:
Phone: 402-370-1060