| NPI | 1891359485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS M MASEK Credentialing Supervisor 402-502-8846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-04-29 |