Healthcare Provider Details

I. General information

NPI: 1588972459
Provider Name (Legal Business Name): MERRICK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 26TH ST
CENTRAL CITY NE
68826-9501
US

IV. Provider business mailing address

1715 26TH STREET
CENTRAL CITY NE
68826-9501
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 TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BOWMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 308-946-3015