Provider Demographics
NPI:1215340096
Name:BARRETT CLINIC PC
Entity type:Organization
Organization Name:BARRETT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-991-9500
Mailing Address - Street 1:8074 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3303
Mailing Address - Country:US
Mailing Address - Phone:402-991-9500
Mailing Address - Fax:402-991-9564
Practice Address - Street 1:8074 S 84TH ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3303
Practice Address - Country:US
Practice Address - Phone:402-991-9500
Practice Address - Fax:402-991-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE110993OtherLICENSE
NE10026518601Medicaid
NE110993OtherLICENSE
NE470376604-12OtherMEDICAID. NE