Healthcare Provider Details

I. General information

NPI: 1881704229
Provider Name (Legal Business Name): VALENTINE MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N CHERRY ST
VALENTINE NE
69201-1518
US

IV. Provider business mailing address

502 N CHERRY ST
VALENTINE NE
69201-1518
US

V. Phone/Fax

Practice location:
  • Phone: 402-376-2200
  • Fax: 402-376-2219
Mailing address:
  • Phone: 402-376-2200
  • Fax: 402-376-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number21205
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE MULLIGAN-WITT
Title or Position: PRESIDENT / CEO
Credential: MD
Phone: 402-376-2200