Provider Demographics
NPI:1962734657
Name:DALE E WEE DC PC
Entity type:Organization
Organization Name:DALE E WEE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-284-2097
Mailing Address - Street 1:1008 W 1ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-1903
Mailing Address - Country:US
Mailing Address - Phone:308-284-2097
Mailing Address - Fax:308-284-2098
Practice Address - Street 1:1008 W 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-1903
Practice Address - Country:US
Practice Address - Phone:308-284-2097
Practice Address - Fax:308-284-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE551261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
09598OtherBLUE CROSS/BLUE SHIELD OF NEBRASKA
P00762160OtherRAILROAD MEDICARE
NE=========00Medicaid
P00762160OtherRAILROAD MEDICARE