Provider Demographics
NPI:1699877423
Name:FAMILY HEALTHCARE OF WAHOO, LLC
Entity type:Organization
Organization Name:FAMILY HEALTHCARE OF WAHOO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:402-443-4141
Mailing Address - Street 1:964 N LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1527
Mailing Address - Country:US
Mailing Address - Phone:402-443-4141
Mailing Address - Fax:402-443-4150
Practice Address - Street 1:964 N LAUREL ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1527
Practice Address - Country:US
Practice Address - Phone:402-443-4141
Practice Address - Fax:402-443-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECK3490OtherRAILROAD MEDICARE
NE=========13Medicaid
NE=========13Medicaid
NE099262Medicare PIN
NE275905Medicare PIN