Healthcare Provider Details

I. General information

NPI: 1528796356
Provider Name (Legal Business Name): INPATIENT PHYSICIAN ASSOCIATES GRAND ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 PRAIRIEVIEW ST
GRAND ISLAND NE
68803-4409
US

IV. Provider business mailing address

PO BOX 6971
LINCOLN NE
68506-0971
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-8566
  • Fax: 402-481-8805
Mailing address:
  • Phone: 402-486-7040
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISSA M CLOUGH
Title or Position: PRESIDENT
Credential: MD
Phone: 402-481-8566