Ivy Street Medical LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

IVY STREET MEDICAL LLC

Practice address

902 Ivy St
Stanton, NE 68779-2348

Phone

(402) 439-5500

Fax

(402) 439-5502

NPI assigned

Oct 14, 2008

Last updated

Oct 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Karla E Damgaard, APRN

Title

Owner

Phone

(402) 439-5500

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacy Ann Froehlich, APRN

  • Family Medicine Physician
  • Lincoln, NE
  • NPI 1316469380
  NPD (past)
• Rodrigo Gomez Cordero, MD

  • Surgery Physician
  • Norfolk, NE
  • NPI 1144384611
  NPD (past)

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1487806147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47",
            "city": "STANTON",
            "state": "NE",
            "postal_code": "687790047",
            "telephone_number": "402-439-5500",
            "fax_number": "402-439-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 IVY ST",
            "city": "STANTON",
            "state": "NE",
            "postal_code": "687792348",
            "telephone_number": "402-439-5500",
            "fax_number": "402-439-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY STREET MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "DAMGAARD",
        "authorized_official_first_name": "KARLA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-439-5500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayanne Hamling, MS., CCC-SLP
• Hannah Elizabeth Harstick
• Donald William Hoehne Jr., DC
• Jordon Hunke
• Jennifer Marie Iliff
• Sara R Kuester
• Jacquelyn L Lienemann, PTA
• Randie Lierman
• Tabitha McBeain
• Bethany Jean Miller

• Rural Health Clinic/Center in Stanton, NE
• Providers in Stanton, NE by specialty
• Rural Health Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.