Provider Demographics
NPI:1215171624
Name:FIRST CARE MEDICAL, PC
Entity type:Organization
Organization Name:FIRST CARE MEDICAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, ATC, NREMT
Authorized Official - Phone:308-236-7016
Mailing Address - Street 1:104 W SENECA ST
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-1363
Mailing Address - Country:US
Mailing Address - Phone:308-236-7016
Mailing Address - Fax:308-236-7027
Practice Address - Street 1:104 W SENECA ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-1363
Practice Address - Country:US
Practice Address - Phone:308-236-7016
Practice Address - Fax:308-236-7027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CARE MEDICAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-29
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28D1100092OtherCLIA ID #
NENA1259OtherMEDICARE PTAN
NE10025764700Medicaid
NEDP1168OtherRAILROAD MEDICARE PTAN