Basic Information
| Provider Information | |||||||||
| NPI: | 1508843491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEBRASKA CANCER CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 N KANSAS AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689014470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024605899 | ||||||||
| FaxNumber: | 4024605619 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 N KANSAS AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689014470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024605899 | ||||||||
| FaxNumber: | 4024605619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | SENGAR | ||||||||
| AuthorizedOfficialFirstName: | ASHVINI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4024605899 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 207RH0003X | 22433 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 10025373400 | 05 | NE | MEDICAID | 10024998500 | 05 | NE | MEDICAID | 10025512000 | 05 | NE | MEDICAID | 10025486700 | 05 | NE | MEDICAID | 10025458600 | 05 | NE | MEDICAID | 10025458500 | 05 | NE | MEDICAID |