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General NPI Number Information
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NPI Number | 1639242621
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Entity Type | Organization
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Legal Business Name | W.V. FATTIG M.D.
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 723 FLACK AVE
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City | ALLIANCE
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State | NE
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Zip | 69301-3514
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Country | US
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Telephone | 308-225-4498
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Fax | 308-646-0341
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Provider Business Mailing Address
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Address Line | 723 FLACK AVE
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City | ALLIANCE
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State | NE
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Zip | 69301-3514
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Country | US
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Telephone | 308-225-4498
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Fax | 308-646-0341
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SANDRA FATTIG
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Credential | CO-OWNER
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Telephone | 308-225-4498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 21201
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License Number State | NE
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