NPIMap

Organization Active NPI

Ponca Tribe of Nebraska

Doing business as Fred LeRoy Health and Wellness Center Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Omaha, NE
National Provider Identifier
1760778385
Registry record updated Jun 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
2884 Issued in NE
Legal business name
PONCA TRIBE OF NEBRASKA
Doing business as
Fred LeRoy Health and Wellness Center Pharmacy
Practice address
2602 J St
Fred Leroy Health and Wellness Center Pharmacy
Omaha, NE 68107-1643
Phone
(402) 734-5275
Fax
(402) 733-3487
NPI assigned
Jun 22, 2011
Last updated
Jun 22, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
PONCA TRIBE OF NEBRASKAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2011

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

Authorized official

Name
Mr. Donald Lee, MS
Title
Chief Executive Officer
Phone
(402) 734-5275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 2884 NE Primary

Addresses

Primary practice location

2602 J St
Fred Leroy Health and Wellness Center Pharmacy
Omaha, NE 68107-1643

Mailing address

2602 J St
Fred Leroy Health and Wellness Center Pharmacy
Omaha, NE 68107-1643
Phone (402) 734-5275

Other identifiers 2

IdentifierTypeStateIssuer
2884OtherNEPHARMACY LICENSE NUMBER
2817964OtherNCPDP

Other names 1

  • Fred LeRoy Health and Wellness Center Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ponca Tribe of Nebraska9 organizations share this tax ID, including this one
Part of
Ponca Tribe of Nebraska

Other organizations with this tax ID 8

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": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308700800000",
    "number": "1760778385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2602 J ST",
            "address_2": "FRED LEROY HEALTH AND WELLNESS CENTER PHARMACY",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071643",
            "telephone_number": "402-734-5275",
            "fax_number": "402-733-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 J ST",
            "address_2": "FRED LEROY HEALTH AND WELLNESS CENTER PHARMACY",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071643",
            "telephone_number": "402-734-5275",
            "fax_number": "402-733-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCA TRIBE OF NEBRASKA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PONCA TRIBE OF NEBRASKA",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "402-734-5275",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NE",
            "license": "2884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE NUMBER",
            "identifier": "2884",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2817964",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fred LeRoy Health and Wellness Center Pharmacy",
            "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 Jun 22, 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.