1841312584 NPI number — CENTRAL NEBRASKA MEDICAL CLINIC, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841312584 NPI number — CENTRAL NEBRASKA MEDICAL CLINIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL NEBRASKA MEDICAL CLINIC, P.C.
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:
6
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:
1841312584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 690
Provider Second Line Business Mailing Address:
145 MEMORIAL DRIVE
Provider Business Mailing Address City Name:
BROKEN BOW
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68822-0690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-872-2486
Provider Business Mailing Address Fax Number:
308-872-2027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANSLEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68814-0706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-935-1367
Provider Business Practice Location Address Fax Number:
308-872-2027
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MINNICK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
308-872-2486

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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)

  • Identifier: 28D0942874 . This is a "CLIA NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com