1174570758 NPI number — COUNTY MEDICAL SERVICES INC.

Table of content: (NPI 1174570758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174570758 NPI number — COUNTY MEDICAL SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY MEDICAL SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAIN STREET MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174570758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED CLOUD
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68970-0467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-746-2282
Provider Business Mailing Address Fax Number:
402-746-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 N WEBSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED CLOUD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68970-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-746-2282
Provider Business Practice Location Address Fax Number:
402-746-2300
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIZZO
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
308-425-6221

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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