1861513954 NPI number — CENTRAL NEBRASKA MEDICAL CLINIC AT SARGENT

Table of content: (NPI 1518402221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861513954 NPI number — CENTRAL NEBRASKA MEDICAL CLINIC AT SARGENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL NEBRASKA MEDICAL CLINIC AT SARGENT
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:
1861513954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARGENT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68874-6101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-527-4300
Provider Business Mailing Address Fax Number:
308-527-9106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARGENT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68874-6101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-527-4300
Provider Business Practice Location Address Fax Number:
308-527-9106
Provider Enumeration Date:
04/03/2007

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
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: 28D0962195 . 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