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Organization

SOUTH SIDE CONVENIENT CARE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SAMANTHA SENANAYAKA PA-C (CLINIC CREDENTIALING CONTACT)
(402) 350-7616
Entity
Organization

Contact information

Practice address
4115 HARRISON ST, BELLEVUE, NE 68147-1059
(402) 932-0692
(402) 614-6731
Mailing address
4115 HARRISON ST, BELLEVUE, NE 68147-1059
(402) 932-0692
(402) 614-6731

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10026666300
NE
Enumeration date
04/20/2017
Last updated
07/17/2023
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