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 |