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SOUTH SIDE CONVENIENT CARE INC NPI 1679007249


NPI Information

NPI: 1679007249
Provider Name: SOUTH SIDE CONVENIENT CARE INC
Classification: Physician Assistant - 363A00000X
Entity Type: Organization

CLIA Number: 28D2132142

Address:
4115 HARRISON ST
BELLEVUE, NE
ZIP 68147
Phone: (402) 932-0692
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SOUTH SIDE CONVENIENT CARE INC is a physician assistant in Bellevue, NE. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. SOUTH SIDE CONVENIENT CARE INC NPI is 1679007249. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4115 HARRISON ST
BELLEVUE, NE
ZIP 68147-059
Phone: (402) 932-0692
Fax: (402) 614-6731

The provider's authorized official is Samantha Senanayaka .
The authorized official title is Clinic Credentialing Contact and has the following contact phone number (402) 350-7616.

The CLIA number assigned to this NPI record is 28D2132142 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2017 and was last updated on 7/17/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician AssistantYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
110026666300MEDICAIDNEBRASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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