| Organization Name: | WAHOO MEDICAL P.C. |
| NPI Number: | 1700115987 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMY ELIZABETH HANNAN (PRESIDENT) |
| Mailing Address: | 567 W 15th St Wahoo |
| State: | NE US |
| Postal Code: | 680661280 |
| Phone Number: | 4024434600 |
| Fax Number: | 4024434660 |
| NPI Enumeration Date: | 12/16/2009 |
| NPI Last Update Date: | 12/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |