Basic Information
| Provider Information | |||||||||
| NPI: | 1013916600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW CENTURY PHYSICIANS OF NEBRASKA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194231 | ||||||||
| Practice Location | |||||||||
| Address1: | 16901 LAKESIDE HILLS CT | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681302318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027178000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOLTZCLAW | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8566864316 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 10041654 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100251217-00 | 05 | NE | MEDICAID | CK8681 | 01 | NE | RRMEDICARE GRP NUMBER | OTHER | 020455400 | 01 | NE | FEDERAL BLACK LUNG | OTHER | 203413200 | 01 | NE | EEOICP | OTHER | 0717264 | 05 | IA | MEDICAID | 203413200 | 01 | NE | DEPT OF LABOR GRP NUMBER | OTHER |