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General NPI Number Information
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NPI Number | 1467858415
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Entity Type | Organization
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Legal Business Name | U MED SPA & WEIGHT MANAGEMENT
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 5609 1ST AVE SUITE B
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City | KEARNEY
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State | NE
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Zip | 68847-2436
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Country | US
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Telephone | 308-224-2131
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Fax | 308-224-2134
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Provider Business Mailing Address
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Address Line | 5609 1ST AVE SUITE B
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City | KEARNEY
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State | NE
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Zip | 68847-2436
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Country | US
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Telephone | 308-224-2131
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Fax | 308-224-2134
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | BRADLEY DARYL RODGERS
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Credential | M.D.
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Telephone | 308-224-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 16658
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License Number State | NE
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