Healthcare Provider Details

I. General information

NPI: 1457887218
Provider Name (Legal Business Name): FAMILY MEDICINE AND URGENT CARE OF WAVERLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 GUILDFORD ST STE D
WAVERLY NE
68462-1453
US

IV. Provider business mailing address

13851 GUILDFORD ST STE D
WAVERLY NE
68462-1453
US

V. Phone/Fax

Practice location:
  • Phone: 402-786-7425
  • Fax: 402-786-7427
Mailing address:
  • Phone: 402-786-7425
  • Fax: 402-786-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY JO WALKER
Title or Position: SUPERVISOR
Credential:
Phone: 402-786-7425