Provider Demographics
NPI:1447471610
Name:VILLAGE POINTE PEDIATRICS, PC
Entity type:Organization
Organization Name:VILLAGE POINTE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SARE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-573-7337
Mailing Address - Street 1:18018 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4417
Mailing Address - Country:US
Mailing Address - Phone:402-573-7337
Mailing Address - Fax:402-614-2314
Practice Address - Street 1:18018 BURKE STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4417
Practice Address - Country:US
Practice Address - Phone:402-573-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-11-18
Deactivation Date:2024-09-09
Deactivation Code:
Reactivation Date:2024-11-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty