Provider Demographics
NPI:1356387831
Name:ADULT & PEDIATRIC UROLOGY, PC
Entity type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCRERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-7989
Mailing Address - Street 1:PO BOX 8577
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-0577
Mailing Address - Country:US
Mailing Address - Phone:402-397-7989
Mailing Address - Fax:402-393-7554
Practice Address - Street 1:10707 PACIFIC ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4762
Practice Address - Country:US
Practice Address - Phone:402-397-7989
Practice Address - Fax:402-397-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0424739Medicaid
NE=========13Medicaid
IA70090Medicare ID - Type UnspecifiedGROUP IOWA MEDICARE
NE=========13Medicaid
NE098396Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER