Healthcare Provider Details

I. General information

NPI: 1306944558
Provider Name (Legal Business Name): HOWARD COUNTY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 KENDALL STREET
SAINT PAUL NE
68873-0405
US

IV. Provider business mailing address

P.O. BOX 405
SAINT PAUL NE
68873-0405
US

V. Phone/Fax

Practice location:
  • Phone: 308-754-5447
  • Fax: 308-754-5449
Mailing address:
  • Phone: 308-754-5447
  • Fax: 308-754-5449

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: MR. THOMAS R. PARISH
Title or Position: CFO
Credential: CPA
Phone: 308-754-4421