# CHRISTOPHER P COSTA MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Costa Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194803353
- **Authorized official:** CHRISTOPHER P COSTA MD (OWNER)
- **Authorized official phone:** (308) 537-2222

## Contact information

- **Practice address:** 514 9TH STREET, GOTHENBURG, NE 69138-1917
- **Practice address phone:** (308) 537-2222
- **Practice address fax:** (308) 537-2960
- **Mailing address:** 514 9TH STREET, GOTHENBURG, NE 69138-1917
- **Mailing address phone:** (308) 537-2222
- **Mailing address fax:** (308) 537-2960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 20028 | NE | Yes |

## Other

- **Enumeration date:** 11/02/2006
- **Last updated:** 10/16/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10025207300 | RURAL HEALTH MEDICAID | NE |
| 05 | — | 10025207400 | — | NE |
| 01 | — | 283850 | RIVERBEND | — |