Healthcare Provider Details

I. General information

NPI: 1184970162
Provider Name (Legal Business Name): QUICK CARE MEDICAL FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 08/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 AVENUE B
SCOTTSBLUFF NE
69361-4303
US

IV. Provider business mailing address

3210 AVENUE B
SCOTTSBLUFF NE
69361-4303
US

V. Phone/Fax

Practice location:
  • Phone: 308-630-0800
  • Fax: 308-630-0842
Mailing address:
  • Phone: 308-630-0800
  • Fax: 308-630-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNE11305
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1332
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1551
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number688
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number386
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110177
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110254
License Number StateNE
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111373
License Number StateNE

VIII. Authorized Official

Name: MR. LAMBERT E STIERS
Title or Position: OWNER/CEO
Credential: PA-C
Phone: 308-630-0800