Healthcare Provider Details

I. General information

NPI: 1417143066
Provider Name (Legal Business Name): FAMILY MEDICINE AND SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 L ST
RALSTON NE
68127-1745
US

IV. Provider business mailing address

8045 L ST
RALSTON NE
68127-1745
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-1600
  • Fax:
Mailing address:
  • Phone: 402-898-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18039
License Number StateNE

VIII. Authorized Official

Name: CHRISTINA RAJ
Title or Position: OFFICE MANAGER/ BILLING
Credential:
Phone: 402-898-1600