1306376074 NPI number — VSL DAVID CITY LLC

Table of content: (NPI 1306376074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306376074 NPI number — VSL DAVID CITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VSL DAVID CITY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306376074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20220 HARNEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHORN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68022-2063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-885-6120
Provider Business Mailing Address Fax Number:
402-895-8165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 S 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVID CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68632-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-367-3144
Provider Business Practice Location Address Fax Number:
402-367-4246
Provider Enumeration Date:
06/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VETTER
Authorized Official First Name:
JACK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHAIRMAN OF THE BOARD
Authorized Official Telephone Number:
402-895-3932

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  94001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 94001 . This is a "FACILITY LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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