Organization
WAHOO FAMILY & SPORTS MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA LOUISE SHIRLEY (OFFICE MANAGER)
(402) 443-4600
Entity
Organization
Contact information
Practice address
567 W 15TH ST, WAHOO, NE 68066-1280
(402) 443-4600
(402) 443-4670
Mailing address
567 W 15TH ST, WAHOO, NE 68066-1280
(402) 443-4600
(402) 443-4670
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
179
NE
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
179
NE
Other
Enumeration date
04/12/2012
Last updated
04/12/2012
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