Healthcare Provider Details

I. General information

NPI: 1639691355
Provider Name (Legal Business Name): SCHROCK MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 W 39TH ST STE A
KEARNEY NE
68845-2922
US

IV. Provider business mailing address

615 W 68TH ST
KEARNEY NE
68845-9505
US

V. Phone/Fax

Practice location:
  • Phone: 308-236-6499
  • Fax: 308-236-2050
Mailing address:
  • Phone: 308-440-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL L SCHROCK
Title or Position: OWNER
Credential:
Phone: 308-440-7796