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General NPI Number Information
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NPI Number | 1053651877
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Entity Type | Organization
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Legal Business Name | MULTIPLE SCLEROSIS CENTER OF NEBRASKA PC
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 575 FALLBROOK BLVD SUITE 204
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City | LINCOLN
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State | NE
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Zip | 68521-9015
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Country | US
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Telephone | 402-483-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 575 FALLBROOK BLVD SUITE 204
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City | LINCOLN
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State | NE
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Zip | 68521-9015
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Country | US
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Telephone | 402-483-0050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JOHN C PUENTE
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Credential | M.D.
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Telephone | 402-483-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22773
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License Number State | NE
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