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General NPI Number Information
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NPI Number | 1629884523
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Entity Type | Organization
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Legal Business Name | PGFHGS HOLDINGS LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 3506 S 201ST CIR
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City | OMAHA
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State | NE
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Zip | 68130-5094
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Country | US
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Telephone | 402-681-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 3506 S 201ST CIR
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City | OMAHA
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State | NE
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Zip | 68130-5094
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Country | US
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Telephone | 402-681-4030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIEL MICHAEL SULLIVAN
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Credential |
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Telephone | 402-681-4030
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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 |
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License Number State |
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