Basic Information
| Provider Information | |||||||||
| NPI: | 1184272577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEBRASKA KIDNEY HEALTH PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 LAKE PARK LN | ||||||||
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| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689012581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029849696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 N SAINT JOSEPH AVE | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689012652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024634893 | ||||||||
| FaxNumber: | 4024637049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2019 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | HABASH | ||||||||
| AuthorizedOfficialFirstName: | RAMEZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4029849696 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.