| Pa Enterprises | |
|
309 S, Lincoln Ave York NE 68467-4225 | |
| (402) 745-6279 | |
| Not Available |
| Full Name | Pa Enterprises |
|---|---|
| Speciality | Family Medicine |
| Location | 309 S, Lincoln Ave, York, Nebraska |
| Authorized Official Name and Position | Bryan Myers (OWNER) |
| Authorized Official Contact | 4027456279 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pa Enterprises 309 S, Lincoln Ave York NE 68467-4225 Ph: (402) 745-6279 | Pa Enterprises 309 S, Lincoln Ave York NE 68467-4225 Ph: (402) 745-6279 |
| NPI Number | 1447653183 |
|---|---|
| Provider Enumeration Date | 10/08/2014 |
| Last Update Date | 08/12/2015 |
| Medicare PECOS PAC ID | 6608193065 |
|---|---|
| Medicare Enrollment ID | O20150323002255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447653183 | NPI | - | NPPES |
| 100264573-00 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Scott L Vonderfecht |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023099678 PECOS PAC ID: 2062540164 Enrollment ID: I20100511000805 |
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