Provider Demographics
NPI:1528302429
Name:NORTH CENTRAL DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:NORTH CENTRAL DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-2406
Mailing Address - Street 1:422 E DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1852
Mailing Address - Country:US
Mailing Address - Phone:402-336-2406
Mailing Address - Fax:402-336-1768
Practice Address - Street 1:422 E DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1852
Practice Address - Country:US
Practice Address - Phone:402-336-2406
Practice Address - Fax:402-336-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100262795-00Medicaid