Basic Information
| Provider Information | |||||||||
| NPI: | 1740491786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOOD NEIGHBOR COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4321 41ST AVENUE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686012131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025628952 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Practice Location | |||||||||
| Address1: | 4321 41ST AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025628952 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | RODGERS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERMIN CEO | ||||||||
| AuthorizedOfficialTelephone: | 4025628952 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 10024980200 | 05 | NE | MEDICAID | 10025076100 | 05 | NE | MEDICAID | 35016 | 01 | NE | BCBS | OTHER | 1740491786 | 01 | NE | MIDLANDS CHOICE | OTHER |