Basic Information
| Provider Information | |||||||||
| NPI: | 1144491564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONEWORLD COMMUNITY HEALTH CENTERS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CASS FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4920 S 30TH ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681071590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027344110 | ||||||||
| FaxNumber: | 4029915642 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | PLATTSMOUTH | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680481934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022962345 | ||||||||
| FaxNumber: | 4022962353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2008 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | SKOLKIN | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4025028842 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | HC018 | NE | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 100255855-00 | 05 | NE | MEDICAID | 10025582700 | 05 | NE | MEDICAID |