Organization
W.V. FATTIG M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA FATTIG CO-OWNER (OFFICE MANAGER)
(308) 225-4498
Entity
Organization
Contact information
Practice address
723 FLACK AVE, ALLIANCE, NE 69301-3514
(308) 225-4498
(308) 646-0341
Mailing address
723 FLACK AVE, ALLIANCE, NE 69301-3514
(308) 225-4498
(308) 646-0341
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
21201
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04137
BCBS
NE
05
—
10025150600
—
NE
01
—
21201
STATE LICENSE
NE
01
—
28D1030805
CLIA
NE
01
—
35808
MIDLANDS CHOICE
NE
01
—
507843624
SS#
NE
01
—
P00181202
RR MEDICARE
NE
Enumeration date
11/16/2006
Last updated
03/07/2023
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