MEDICARE: CITY OF GENOA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CS4410	OTHER	NE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	273722254	OTHER	NE	COMMERCIAL
4	273722254	OTHER	NE	BLUE CROSS BLUE SHIELD
6	NA	OTHER	NE	CHAMPUS

General Provider Information

NPI Number	:	1104859206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF GENOA

Provider Business Mailing Address
First Line	:	505 S PARK ST
Second Line	:	PO BOX 310
City	:	GENOA
State	:	NE
Zip	:	68640-3036
Country	:	US
Telephone Number	:	402-993-2206
Fax Number	:	402-993-2595

Provider Business Practice Location Address
First Line	:	505 S PARK ST
Second Line	:
City	:	GENOA
State	:	NE
Zip	:	68640-3036
Country	:	US
Telephone Number	:	402-993-2206
Fax Number	:	402-993-2595

Authorized Official
Title or Position	:	CEO
Name	:	AMANDA ROEBUCK
Credential	:
Telephone Number	:	402-993-4583

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/23/2020

Similar Medicare Providers

1336127950 — MR. STEVE D WATTON PA C
Practice Location Address:

505 S PARK ST , PARK STREET MEDICAL CLINIC
GENOA, NE
68640-3036

Practice Phone: 402-993-2206
Practice Fax: 402-993-2595

1386077535 — MRS. JENNIFER LYNN SWANTEK APRN
Practice Location Address:

505 S PARK ST
GENOA, NE
68640-3036

Practice Phone: 402-993-2206
Practice Fax: 402-993-2595

1720505522 — CITY OF GENOA
Practice Location Address:

505 S PARK ST
GENOA, NE
68640-3036

Practice Phone: 402-993-2205
Practice Fax: 402-993-2595

1326723818 — JENNA PATRCIA ABRAMSON PA-C
Practice Location Address:

505 S PARK ST
GENOA, NE
68640-3036

Practice Phone: 402-993-2206
Practice Fax: 402-993-2595

1487621561 — CITY OF GENOA
Practice Location Address:

516 WILLARD AVE
GENOA, NE
68640-3039

Practice Phone: 402-572-4019
Practice Fax: 402-965-8594

1649228511 — CITY OF GENOA
Practice Location Address:

706 EWING ST
GENOA, NE
68640-3035

Practice Phone: 402-993-2283
Practice Fax: 402-993-2373

Directions to “CITY OF GENOA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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