1891576401 NPI number — SCHROCK MEDICAL CLINIC PC

Table of content: (NPI 1891576401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891576401 NPI number — SCHROCK MEDICAL CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHROCK MEDICAL CLINIC PC
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:
Provider Other Organization Name Type Code:
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:
1891576401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 W 39TH ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68845-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-236-6499
Provider Business Mailing Address Fax Number:
308-236-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4546 S 86TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68526-9252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-817-1999
Provider Business Practice Location Address Fax Number:
402-817-1559
Provider Enumeration Date:
10/10/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRELLWITZ
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
308-236-6499

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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