Healthcare Provider Details

I. General information

NPI: 1477387439
Provider Name (Legal Business Name): REPUBLIC MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 FARNAM ST
OMAHA NE
68102-1880
US

IV. Provider business mailing address

100 S 19TH ST APT 309
OMAHA NE
68102-1339
US

V. Phone/Fax

Practice location:
  • Phone: 800-388-4047
  • Fax:
Mailing address:
  • Phone: 951-233-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE FURNACE
Title or Position: CEO
Credential: APRN
Phone: 951-233-6477