Provider Demographics
NPI:1447434261
Name:PONCA TRIBE OF NEBRASKA
Entity type:Organization
Organization Name:PONCA TRIBE OF NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:REIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-347-6781
Mailing Address - Street 1:1800 SYRACUSE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2458
Mailing Address - Country:US
Mailing Address - Phone:402-371-8834
Mailing Address - Fax:
Practice Address - Street 1:1800 SYRACUSE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2458
Practice Address - Country:US
Practice Address - Phone:402-371-8834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid