Organization
NEW CENTURY PHYSICIANS OF NEBRASKA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN G HOLTZCLAW MD (OWNER)
(856) 575-4316
Entity
Organization
Contact information
Practice address
11111 S 84TH ST, PAPILLION, NE 68046-4122
(402) 593-3550
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
10041654
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020455400
FEDERAL BLACK LUNG
NE
01
—
0580753
IOWA MEDICAID GRP NUMBER
NE
05
—
100249951-00
—
NE
01
—
203413200
DEPT OF LABOR
NE
01
—
203413201
EEOICP
NE
Enumeration date
07/14/2005
Last updated
12/30/2014
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