MEDICARE: NEBRASKA VEIN CARE P.C.

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1255773693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEBRASKA VEIN CARE P.C.

Provider Business Mailing Address
First Line	:	1414 NORTH 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-640-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 NORTH 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-640-5139
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JOE HORSTMAN
Credential	:	RVT, RDCS
Telephone Number	:	402-640-5139

Provider Enumeration Date	:	07/26/2013
Last Update Date	:	07/26/2013

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