Healthcare Provider Details

I. General information

NPI: 1881269827
Provider Name (Legal Business Name): WINNEBAGO TRIBE OF NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S BLUFF ST
WINNEBAGO NE
68071
US

IV. Provider business mailing address

225 S BLUFF ST
WINNEBAGO NE
68071
US

V. Phone/Fax

Practice location:
  • Phone: 140-287-3591
  • Fax: 402-878-2237
Mailing address:
  • Phone: 140-287-3591
  • Fax: 402-878-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARLENE J GRANT
Title or Position: REVENUE CYCLE COORDINATOR
Credential:
Phone: 402-878-3591