Basic Information
| Provider Information | |||||||||
| NPI: | 1902941289 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY OF NEBRASKA BOARD OF REGENTS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY OF NEBRASKA-LINCOLN, UNIVERSITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 880618 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685880618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024727435 | ||||||||
| FaxNumber: | 4024724593 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 U ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024727488 | ||||||||
| FaxNumber: | 4024728010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 01/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VC BUSINESS & FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4024724455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 10025123700 | 05 | NE | MEDICAID | 10025121400 | 05 | NE | MEDICAID | 10025121300 | 05 | NE | MEDICAID |