Provider Demographics
NPI:1841687191
Name:PHYSICIANS CLINIC INC
Entity type:Organization
Organization Name:PHYSICIANS CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-354-5609
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2100
Practice Address - Street 1:11946 STANDING STONE DRIVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-8094
Practice Address - Country:US
Practice Address - Phone:402-815-4500
Practice Address - Fax:402-815-4510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-23
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0561160025Medicare NSC