=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013125244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVCO HEALTH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2007
-----------------------------------------------------
Last Update Date | 04/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1630 S 70TH ST SUITE 201
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-488-3946
-----------------------------------------------------
Fax | 402-488-6031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6831 SUMNER ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-488-3946
-----------------------------------------------------
Fax | 402-488-6031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | DR. KATHY L. HAVLICEK
-----------------------------------------------------
Credential | PH.D. APRN-BC, NP-C
-----------------------------------------------------
Telephone | 402-488-3946
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 110806
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------