Healthcare Provider Details

I. General information

NPI: 1487837696
Provider Name (Legal Business Name): MIDTOWN HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W PHILLIP AVE
NORFOLK NE
68701-5248
US

IV. Provider business mailing address

302 W PHILLIP AVE
NORFOLK NE
68701-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-8000
  • Fax: 402-371-0971
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 Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberHC050
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberHC050
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberHC050
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberHC050
License Number StateNE

VIII. Authorized Official

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