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NPI Code Detail

MEDICARE: CITY OF GENOA

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
1282NC0060XCritical Access Hospital550001NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100185OTHERNEBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1649228511
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY OF GENOA
Provider Business Mailing Address
First Line : PO BOX 310
Second Line :
City : GENOA
State : NE
Zip : 68640-0310
Country : US
Telephone Number : 402-993-2283
Fax Number : 402-993-2373
Provider Business Practice Location Address
First Line : 706 EWING ST
Second Line :
City : GENOA
State : NE
Zip : 68640-3035
Country : US
Telephone Number : 402-993-2283
Fax Number : 402-993-2373
Authorized Official
Title or Position : CEO
Name : AMANDA ROEBUCK
Credential :
Telephone Number : 402-993-4583
Provider Enumeration Date : 05/04/2006
Last Update Date : 01/23/2020

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1720579220 — KIMBERLY ANN PFEIFER MS, RD, LMNT
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Directions to “CITY OF GENOA ” Practice Location

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