Basic Information
| Provider Information | |||||||||
| NPI: | 1265432223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC PARTNERS L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E. 29TH ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027532900 | ||||||||
| FaxNumber: | 4027532926 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E. 29TH ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027532900 | ||||||||
| FaxNumber: | 4027532926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MACDONALD | ||||||||
| AuthorizedOfficialFirstName: | MADELEINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 4027532900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 19644 | NE | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 18393 | NE | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363LF0000X | 110604 | NE | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | 110475 | NE | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.