Healthcare Provider Details

I. General information

NPI: 1790216174
Provider Name (Legal Business Name): MERRICK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 28TH ST
CENTRAL CITY NE
68826-2707
US

IV. Provider business mailing address

PO BOX 860874
MINNEAPOLIS MN
55486-0874
US

V. Phone/Fax

Practice location:
  • Phone: 308-946-3015
  • Fax: 308-946-5914
Mailing address:
  • Phone: 308-946-3015
  • Fax: 308-946-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JODI S MOHR
Title or Position: CEO
Credential:
Phone: 402-946-3015