MEDICARE: MARTIN N KATAMBWA PA-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	363AM0700X	Medical Physician Assistant	085004591	IL
2	363AM0700X	Medical Physician Assistant	2003004599	MO
3	363AM0700X	Medical Physician Assistant	2036	NE

General Provider Information

NPI Number	:	1881669075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN N KATAMBWA PA-C

Provider Business Mailing Address
First Line	:	4502 N 206TH ST
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-6992
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 N 22ND ST
Second Line	:
City	:	BLAIR
State	:	NE
Zip	:	68008-1128
Country	:	US
Telephone Number	:	402-426-4611
Fax Number	:	402-426-4642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	04/30/2018

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Directions to “ MARTIN N KATAMBWA PA-C” Practice Location

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