Healthcare Provider Details

I. General information

NPI: 1497051015
Provider Name (Legal Business Name): SANCTA FAMILIA HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 BURT CIR
OMAHA NE
68114-2094
US

IV. Provider business mailing address

10506 BURT CIR
OMAHA NE
68114-2094
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-3393
  • Fax: 402-991-3390
Mailing address:
  • Phone: 402-991-3393
  • Fax: 402-991-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD A PIERRE JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 402-991-3393