Healthcare Provider Details

I. General information

NPI: 1366061400
Provider Name (Legal Business Name): PHYSICIANS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 EAST PIERCE STREET
COUNCIL BLUFFS IA
51503-4626
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 712-396-4360
  • Fax: 712-396-7069
Mailing address:
  • Phone: 402-354-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KERI CHARRON
Title or Position: DIRECTOR
Credential:
Phone: 402-354-5602