NPIMap

Organization Active NPI

Kubat Pharmacy, LLC

  • Durable Medical Equipment & Medical Supplies
  • Fremont, NE
National Provider Identifier
1265628259
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
KUBAT PHARMACY, LLC
Practice address
424 W 23Rd St
Fremont, NE 68025-1211
Phone
(402) 727-1070
Fax
(402) 727-3982
NPI assigned
Sep 24, 2007
Organization subpart
Yes
Parent organization
PERCIPIO RESPIRATORY HOLDCO, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brian Paul Daniel
Title
Chief Operating Officer
Phone
(402) 315-1944

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

424 W 23Rd St
Fremont, NE 68025-1211

Mailing address

3206 S 71St St
Omaha, NE 68106-3507
Phone (402) 558-1192

Other practice location 1

350 W 23rd St
Fremont, NE 68025-2592
Phone (402) 727-4044

Other identifiers 2

IdentifierTypeStateIssuer
2817558OtherNCPDP
10025579000MedicaidNE

Other names 2

  • Kubat HealthCare Doing business as
  • Kubat Pharmacy, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120127000247 NE DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 5597883959 Practice locations: Fremont, NE

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kubat Pharmacy424 W 23Rd St, Fremont, NE 68025-1211(402) 727-1070 Ostomy Supplies|Tracheotomy Supplies|Urological Supplies|Enteral Nutrients|Continuous Positive Airway Pressure (CPAP) Devices|Mechanical In-Exsufflation Devices|Nebulizer Equipment and/or Supplies|Oxygen Equipment and/or Supplies|Respiratory Assist Devices|Respiratory Suction Pumps Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Kubat Pharmacy Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

350 W 23rd St
Fremont, NE 68025
Phone (402) 721-2444

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1265628259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3206 S 71ST ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681063507",
            "telephone_number": "402-558-1192",
            "fax_number": "402-558-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W 23RD ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680251211",
            "telephone_number": "402-727-1070",
            "fax_number": "402-727-3982"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 W 23rd St",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "NE",
            "postal_code": "680252592",
            "country_code": "US",
            "telephone_number": "402-727-4044",
            "fax_number": "402-727-4244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KUBAT PHARMACY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PERCIPIO RESPIRATORY HOLDCO, LLC",
        "enumeration_date": "2007-09-24",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "402-315-1944",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2817558",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025579000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kubat HealthCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kubat Pharmacy, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Kubat Pharmacy, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fremont, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.