| NPI | 1407264419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL KOCH Organizer And Authorized Rep. 308-882-5532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NE 1800) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |