NPIMap

Organization Active NPI

Kohll'S Pharmacy & Homecare Inc

  • Family Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1740599893
Registry record updated Jan 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
KOHLL'S PHARMACY & HOMECARE INC
Doing business as
PREVENTATIVE MEDICAL CLINIC
Practice address
12741 Q St
Omaha, NE 68137-3211
Phone
(402) 895-6812
Fax
(402) 895-7655
NPI assigned
Oct 6, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2011

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

Authorized official

Name
Mr. Justin M Kohll, RPH
Title
Owner
Phone
(402) 108-0012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

12741 Q St
Omaha, NE 68137-3211

Mailing address

12741 Q St
Omaha, NE 68137-3211
Phone (402) 895-6812

Other names 1

  • PREVENTATIVE MEDICAL CLINIC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1740599893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12741 Q ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681373211",
            "telephone_number": "402-895-6812",
            "fax_number": "402-895-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12741 Q ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681373211",
            "telephone_number": "402-895-6812",
            "fax_number": "402-895-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOHLL'S PHARMACY & HOMECARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-06",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "KOHLL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-108-0012",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREVENTATIVE MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; 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.