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General NPI Number Information
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NPI Number | 1457819922
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Entity Type | Organization
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Legal Business Name | PROVIDENCE MEDICAL CENTER
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 803 PROVIDENCE RD STE 101
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City | WAYNE
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State | NE
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Zip | 68787-1590
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Country | US
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Telephone | 402-375-8862
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Fax | 402-375-8863
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Provider Business Mailing Address
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Address Line | 1200 PROVIDENCE RD
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City | WAYNE
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State | NE
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Zip | 68787-1212
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Country | US
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Telephone | 402-375-7920
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Fax | 402-375-7605
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | KIMBERLY LUEDERS
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Credential |
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Telephone | 402-375-7920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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