Healthcare Provider Details

I. General information

NPI: 1700072261
Provider Name (Legal Business Name): VACCINATION SERVICES OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 H CT
OMAHA NE
68127-1246
US

IV. Provider business mailing address

9320 H CT
OMAHA NE
68127-1246
US

V. Phone/Fax

Practice location:
  • Phone: 402-964-0542
  • Fax: 402-964-0545
Mailing address:
  • Phone: 402-964-0542
  • Fax: 402-964-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN KOHLL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 402-964-0542