Provider Demographics
NPI:1053858860
Name:FREMONT HEALTH CLINIC
Entity type:Organization
Organization Name:FREMONT HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-727-1610
Mailing Address - Street 1:2540 N HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2315
Mailing Address - Country:US
Mailing Address - Phone:402-941-5073
Mailing Address - Fax:
Practice Address - Street 1:2540 N HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2315
Practice Address - Country:US
Practice Address - Phone:402-941-5073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREMONT HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-31
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty