Provider Demographics
NPI:1336290972
Name:MCCOOK FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:MCCOOK FAMILY MEDICINE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-344-8784
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-1207
Mailing Address - Country:US
Mailing Address - Phone:308-344-4110
Mailing Address - Fax:
Practice Address - Street 1:1301 E H ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3482
Practice Address - Country:US
Practice Address - Phone:308-344-4110
Practice Address - Fax:308-344-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========12Medicaid