Provider Demographics
NPI:1720505522
Name:CITY OF GENOA
Entity type:Organization
Organization Name:CITY OF GENOA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-993-4583
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NE
Mailing Address - Zip Code:68640-0425
Mailing Address - Country:US
Mailing Address - Phone:402-993-2206
Mailing Address - Fax:402-993-2595
Practice Address - Street 1:505 S PARK ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NE
Practice Address - Zip Code:68640-3036
Practice Address - Country:US
Practice Address - Phone:402-993-2205
Practice Address - Fax:402-993-2595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF GENOA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health