Healthcare Provider Details

I. General information

NPI: 1255773693
Provider Name (Legal Business Name): NEBRASKA VEIN CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NORTH 13TH ST
NORFOLK NE
68701-2669
US

IV. Provider business mailing address

1414 NORTH 13TH ST
NORFOLK NE
68701-2669
US

V. Phone/Fax

Practice location:
  • Phone: 402-640-5139
  • Fax:
Mailing address:
  • Phone: 402-640-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE HORSTMAN
Title or Position: MANAGER
Credential: RVT, RDCS
Phone: 402-640-5139