Provider Demographics
NPI:1306944558
Name:HOWARD COUNTY MEDICAL CLINIC
Entity type:Organization
Organization Name:HOWARD COUNTY MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:308-754-4421
Mailing Address - Street 1:P.O. BOX 405
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-0405
Mailing Address - Country:US
Mailing Address - Phone:308-754-5447
Mailing Address - Fax:308-754-5449
Practice Address - Street 1:1122 KENDALL STREET
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-0405
Practice Address - Country:US
Practice Address - Phone:308-754-5447
Practice Address - Fax:308-754-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid