=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821283896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD C WELDON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2007
-----------------------------------------------------
Last Update Date | 09/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 N 10TH ST
-----------------------------------------------------
City | BEATRICE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68310-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-228-3545
-----------------------------------------------------
Fax | 402-228-3826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 N 10TH ST
-----------------------------------------------------
City | BEATRICE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68310-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-228-3545
-----------------------------------------------------
Fax | 402-228-3826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | CARMEN A MCKEEVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-228-3545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 16679
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------