Healthcare Provider Details

I. General information

NPI: 1578668232
Provider Name (Legal Business Name): CENTRAL NEBRASKA MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MEMORIAL DRIVE
BROKEN BOW NE
68822
US

IV. Provider business mailing address

PO BOX 690
BROKEN BOW NE
68822
US

V. Phone/Fax

Practice location:
  • Phone: 308-872-2486
  • Fax: 308-872-2026
Mailing address:
  • Phone: 308-872-2486
  • Fax: 308-872-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A MINNICK
Title or Position: OWNER PARTNER
Credential: MD
Phone: 308-872-2486