PONCA TRIBE OF NEBRASKA (NPI# 1760778385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760778385 |
| Entity Type | Organization |
| Organization Name | PONCA TRIBE OF NEBRASKA |
| Other Organization Name | FRED LEROY HEALTH AND WELLNESS CENTER PHARMACY |
| Practice Address |
2602 J St Fred Leroy Health and Wellness Center Pharmacy Omaha NE 68107-1643 |
| Practice Telephone | 4027345275 |
| Practice Fax Number | 4027333487 |
| Mailing Telephone | 4027345275 |
| Mailing Fax Number | 4027333487 |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |
| Authorized Official Name | MR. DONALD LEE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4027345275 |
| Authorized Official Credential | MS |
| Is Organization Subpart | Y |
| Parent Organization Name | PONCA TRIBE OF NEBRASKA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2884 | NE | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | PHARMACY LICENSE NUMBER | 2884 | 01 |
| NCPDP | 2817964 | 01 |
| Other Name | Type Code |
|---|---|
| Fred LeRoy Health and Wellness Center Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598930117 | Ponca Tribe of Nebraska | Community/Behavioral Health | 1701 E St, Lincoln, NE 68508-3429 | 2008-04-24 |
| 1447434261 | Ponca Tribe of Nebraska | Community/Behavioral Health | 1800 Syracuse Ave, Norfolk, NE 68701-2458 | 2007-12-28 |
| 1194244939 | Ponca Tribe of Nebraska | Clinic/Center | 2602 J St, Omaha, NE 68107-1643 | 2017-09-13 |
| 1740681832 | Ponca Tribe of Nebraska | Clinic/Center | 2602 J St, Omaha, NE 68107-1643 | 2014-09-09 |
| 1013260561 | Ponca Tribe of Nebraska | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1800 Syracuse Ave, Norfolk, NE 68701-2458 | 2012-10-22 |
| 1285987735 | Ponca Tribe of Nebraska | Clinic/Center | 1800 Syracuse Ave, Norfolk, NE 68701-2458 | 2012-10-22 |
| 1295058733 | Ponca Tribe of Nebraska | Community/Behavioral Health | 2602 J St, Omaha, NE 68107-1643 | 2010-03-11 |
| 1356673040 | Ponca Tribe of Nebraska | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2602 J St, Omaha, NE 68107-1643 | 2010-02-04 |
| 1710172879 | Ponca Tribe of Nebraska | Case Management | 2602 J St, Omaha, NE 68107-1643 | 2007-09-12 |
| Street Address |
2602 J ST FRED LEROY HEALTH AND WELLNESS CENTER PHARMACY |
| City | OMAHA |
| State | NE |
| Zip Code | 68107-1643 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700871381 | Mary Margaret Murphy | Nurse Practitioner | 2602 J St, Omaha, NE 68107-1643 | 2005-09-20 |
| 1033739537 | Rachael M Bogacz | Counselor | 2602 J St, Omaha, NE 68107-1643 | 2020-04-24 |
| 1821632266 | Alison Jordan | Dietitian, Registered | 2602 J St, Omaha, NE 68107-1643 | 2019-10-29 |
| 1669964003 | Tayler Danyelle Fuller | Dentist | 2602 J St, Omaha, NE 68107-1643 | 2018-06-01 |
| 1205335502 | Lorri Lynne Mckean | Dental Hygienist | 2602 J St, Omaha, NE 68107-1643 | 2018-02-02 |
| 1326567660 | Maria Douthett | Nurse Practitioner | 2602 J St, Omaha, NE 68107-1643 | 2017-09-19 |
| 1194244939 | Ponca Tribe of Nebraska | Clinic/Center | 2602 J St, Omaha, NE 68107-1643 | 2017-09-13 |
| 1851772776 | Tracy Lautt | Dental Hygienist | 2602 J St, Omaha, NE 68107-1643 | 2015-06-16 |
| 1326441098 | Whitney Anne Arnold | Registered Nurse | 2602 J St, Omaha, NE 68107-1643 | 2014-10-08 |
| 1679974455 | Nicole Leigh Rezac | Dietitian, Registered | 2602 J St, Omaha, NE 68107-1643 | 2014-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326404773 | Halee Austin Emerson | Speech-Language Pathologist | 5101 S 17th Street, Omaha, NE 68107 | 2016-01-14 |
| 1942513494 | Oneworld Community Health Centers, Inc. | Clinic/Center | 4215 S 20th St, Omaha, NE 68107 | 2010-07-26 |
| 1871740753 | Dawson E Dvorak | Counselor | 5217 S. 28th Street, Stephen Center Hero Program, Omaha, NE 68107 | 2008-08-22 |
| 1750547485 | Concentra Health Services, Inc. | Clinic/Center | 2900 F Street, Omaha, NE 68107 | 2008-08-01 |
| 1164550836 | Joyce A Sargent | Pharmacist | 3548 Q Street, Omaha, NE 68107 | 2007-03-02 |
| 1326192758 | Elizabeth H Buschkemper | Nurse Practitioner | 4920 S. 30th St. Suite 103, Oneworld Community Health Center, Omaha, NE 68107 | 2007-01-23 |
| 1578647772 | Heartland Emergicare | Emergency Medicine | Heartland Emergicare, 2429 M Str, Omaha, NE 68107 | 2006-10-24 |
| 1225125057 | Physicians Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 3353 L Street, Omaha, NE 68107 | 2006-10-05 |
| 1033135595 | Heartland Emergicare, P.C. | Physician Assistant | 2429 M Street, Omaha, NE 68107 | 2006-07-15 |
| 1487695870 | Patricia Rose Farrell | Social Worker | 5511 S 31st St, Omaha, NE 68107 | 2006-06-09 |
| Find all providers in zip 68107 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356673040 | Ponca Tribe of Nebraska | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2602 J St, Omaha, NE 68107-1643 | 2010-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154451730 | Winnebago Ihs Hospital Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Us Highway 77 75, Winnebago, NE 68071 | 2007-03-06 |
| 1972630234 | Santee Clinic Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 110 S. Visiting Eagle Street, Niobrara, NE 68760 | 2007-02-27 |
| 1891284022 | Winnebago Tribe of Nebraska | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 225 South Bluff Street, Winnebago, NE 68071 | 2018-05-03 |
| 1013260561 | Ponca Tribe of Nebraska | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1800 Syracuse Ave, Norfolk, NE 68701-2458 | 2012-10-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.