NPIMap

Organization Active NPI

Providence Medical Center

  • Long Term Care Pharmacy
  • Wayne, NE
National Provider Identifier
1700626645
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
PROVIDENCE MEDICAL CENTER
Practice address
803 Providence Rd Ste 101
Wayne, NE 68787-1590
Phone
(402) 375-8862
Fax
(402) 375-8863
NPI assigned
May 29, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Authorized official

Name
Kimberly Lueders
Title
Pharmacy Director
Phone
(402) 375-7920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

803 Providence Rd Ste 101
Wayne, NE 68787-1590

Mailing address

1200 Providence Rd
Wayne, NE 68787-1212
Phone (402) 375-7920

Other names 1

  • Providence Community Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Providence Medical Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1700626645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 PROVIDENCE RD",
            "city": "WAYNE",
            "state": "NE",
            "postal_code": "687871212",
            "telephone_number": "402-375-7920",
            "fax_number": "402-375-7605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 PROVIDENCE RD STE 101",
            "city": "WAYNE",
            "state": "NE",
            "postal_code": "687871590",
            "telephone_number": "402-375-8862",
            "fax_number": "402-375-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "LUEDERS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "402-375-7920"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayne, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.