MEDICARE: LOUP BASIN PUBLIC HEALTH DEPARTMENT

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	261QP0905X	State or Local Public Health Clinic/Center

General Provider Information

NPI Number	:	1528372562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUP BASIN PUBLIC HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	P.O. BOX 995
Second Line	:	295 NORTH 8TH AVE
City	:	BURWELL
State	:	NE
Zip	:	68823
Country	:	US
Telephone Number	:	308-346-5795
Fax Number	:	308-346-9106

Provider Business Practice Location Address
First Line	:	295 N 8TH AVE
Second Line	:
City	:	BURWELL
State	:	NE
Zip	:	68823-4168
Country	:	US
Telephone Number	:	308-346-5795
Fax Number	:	308-346-9106

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. CHARLES A CONE
Credential	:	C.E.O.
Telephone Number	:	308-346-5795

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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