Basic Information
Provider Information | |||||||||
NPI: | 1093885725 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEBRASKA CANCER CARE LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 815 N KANSAS AVE STE 100 | ||||||||
Address2: |   | ||||||||
City: | HASTINGS | ||||||||
State: | NE | ||||||||
PostalCode: | 689014470 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4024605899 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 815 N KANSAS AVE STE 100 | ||||||||
Address2: |   | ||||||||
City: | HASTINGS | ||||||||
State: | NE | ||||||||
PostalCode: | 689014470 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4024605899 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/09/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SENGAR | ||||||||
AuthorizedOfficialFirstName: | ASHVINI | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 4024605899 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X |   |   | X |   | Suppliers | Prosthetic/Orthotic Supplier |   | 3336C0002X |   |   | X |   | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.