| Innovative Community Health Institute Llc | |
|
4911 N 26th St Lincoln NE 68521-4739 | |
| (402) 826-3222 | |
| (402) 826-3228 |
| Full Name | Innovative Community Health Institute Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4911 N 26th St, Lincoln, Nebraska |
| Authorized Official Name and Position | Josue D Gutierrez (PRESIDENT/OWNER) |
| Authorized Official Contact | 4028263222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Community Health Institute Llc 4911 N 26th St Ste 101 Lincoln NE 68521-4739 Ph: (402) 826-3222 | Innovative Community Health Institute Llc 4911 N 26th St Lincoln NE 68521-4739 Ph: (402) 826-3222 |
| NPI Number | 1851859334 |
|---|---|
| Provider Enumeration Date | 03/04/2019 |
| Last Update Date | 05/01/2025 |
| Medicare PECOS PAC ID | 0840530150 |
|---|---|
| Medicare Enrollment ID | O20190325001140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851859334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Theresa Oltman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679823967 PECOS PAC ID: 4981856150 Enrollment ID: I20140827001105 |
| Provider Name | Josue D Gutierrez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790123982 PECOS PAC ID: 1850522582 Enrollment ID: I20150102001440 |
| Provider Name | Christina Ann Dux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194385815 PECOS PAC ID: 8123450947 Enrollment ID: I20191118000509 |
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