Healthcare Provider Details

I. General information

NPI: 1598766735
Provider Name (Legal Business Name): GRAND ISLAND CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 W FAIDLEY AVE
GRAND ISLAND NE
68803-4327
US

IV. Provider business mailing address

PO BOX 550
GRAND ISLAND NE
68802-0550
US

V. Phone/Fax

Practice location:
  • Phone: 130-838-2110
  • Fax: 308-385-0796
Mailing address:
  • Phone: 308-382-1100
  • Fax: 308-385-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS J HERBEK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 308-382-1100