| NPI | 1740592534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ANDREW TRIBA Owner 402-330-1652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NE 912) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: NE 912) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2010-10-15 |