Healthcare Provider Details

I. General information

NPI: 1093801888
Provider Name (Legal Business Name): PHYSICIANS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MAIN STREET
LOUISVILLE NE
68037
US

IV. Provider business mailing address

8601 WEST DODGE ROAD SUITE # 216
OMAHA NE
68114
US

V. Phone/Fax

Practice location:
  • Phone: 402-234-2502
  • Fax:
Mailing address:
  • Phone: 402-354-4822
  • Fax: 402-354-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD D. GRAGES
Title or Position: PRESIDENT
Credential:
Phone: 402-354-5601