| NPI | 1467976308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK DWAINE GANYO President & Executive D Irector 402-483-8893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-07-21 |