Healthcare Provider Details

I. General information

NPI: 1497308662
Provider Name (Legal Business Name): MIDTOWN HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PROVIDENCE RD
WAYNE NE
68787-1212
US

IV. Provider business mailing address

302 W PHILLIP AVE
NORFOLK NE
68701-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-8000
  • Fax: 402-371-0971
Mailing address:
  • Phone: 402-371-8000
  • Fax: 402-371-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MELODEE J DRENKOW
Title or Position: SYSTEMS AUDITOR/CREDENTIALING
Credential:
Phone: 402-370-1064