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General NPI Number Information
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NPI Number | 1386157071
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Entity Type | Organization
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Legal Business Name | CITY OF GENOA
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 303 BROADWAY ST
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City | FULLERTON
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State | NE
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Zip | 68638-3152
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Country | US
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Telephone | 402-993-2283
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 310
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City | GENOA
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State | NE
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Zip | 68640-0310
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Country | US
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Telephone | 402-993-2283
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMANDA ROEBUCK
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Credential |
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Telephone | 402-993-4583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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