Healthcare Provider Details

I. General information

NPI: 1861582017
Provider Name (Legal Business Name): PHYSICIANS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE EDMUNDSON PLACE SUITE # 310
COUNCIL BLUFFS IA
51503
US

IV. Provider business mailing address

8601 WEST DODGE ROAD SUITE # 216
OMAHA NE
68114
US

V. Phone/Fax

Practice location:
  • Phone: 712-396-4360
  • Fax: 712-396-7069
Mailing address:
  • Phone: 402-354-4822
  • 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: MR. TODD D. GRAGES
Title or Position: PRESIDENT
Credential:
Phone: 402-354-5601