Healthcare Provider Details

I. General information

NPI: 1356426209
Provider Name (Legal Business Name): BRADY RURAL HEALTH CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N MAIN ST
BRADY NE
69123-0157
US

IV. Provider business mailing address

PO BOX 157
BRADY NE
69123-0157
US

V. Phone/Fax

Practice location:
  • Phone: 308-584-3770
  • Fax: 308-584-3772
Mailing address:
  • Phone: 308-584-3770
  • Fax: 308-584-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number12802
License Number StateNE

VIII. Authorized Official

Name: MS. CYNTHIA M COTTON
Title or Position: OFFICE MANAGER
Credential: MLT
Phone: 308-584-3770