Provider Demographics
NPI:1063164523
Name:BOARD OF REGENTS, UNIVERSITY OF NEBRASKA
Entity type:Organization
Organization Name:BOARD OF REGENTS, UNIVERSITY OF NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR BUSINESS AND FINANC
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-865-8205
Mailing Address - Street 1:2510 11TH AVENUE, MCAB 184
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68849
Mailing Address - Country:US
Mailing Address - Phone:308-865-8218
Mailing Address - Fax:308-865-8680
Practice Address - Street 1:2510 11TH AVENUE, MSAB RM 184
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68849
Practice Address - Country:US
Practice Address - Phone:308-865-8964
Practice Address - Fax:308-865-8218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF REGENTS, UNIVERSITY OF NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health