NPI | 1992358824 |
---|---|
Entity Type | Organization |
Authorized Contact | MELODEE J DRENKOW Syst EMS Auditor/Credentialing 402-370-1064 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QD0000X Clinic/Center Dental |
Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
Enumeration Date | 2019-07-19 |
Last Update Date | 2020-07-09 |