Healthcare Provider Details

I. General information

NPI: 1104868496
Provider Name (Legal Business Name): PLUM CREEK MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BUFFALO BND
LEXINGTON NE
68850-1528
US

IV. Provider business mailing address

1103 BUFFALO BND PO BOX 797
LEXINGTON NE
68850-1528
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-6386
  • Fax: 308-324-6913
Mailing address:
  • Phone: 308-324-6386
  • Fax: 308-324-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES NAEVE
Title or Position: ADMINISTRATOR
Credential:
Phone: 308-324-6386