Provider Demographics
NPI:1316240815
Name:DAVID JAMESON
Entity type:Organization
Organization Name:DAVID JAMESON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:402-764-2491
Mailing Address - Street 1:1356 - 126TH ROAD
Mailing Address - Street 2:
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-6240
Mailing Address - Country:US
Mailing Address - Phone:402-764-2491
Mailing Address - Fax:402-764-4033
Practice Address - Street 1:1356 - 126TH ROAD
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666
Practice Address - Country:US
Practice Address - Phone:402-764-2491
Practice Address - Fax:402-764-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty