Healthcare Provider Details

I. General information

NPI: 1376596809
Provider Name (Legal Business Name): YORK MEDICAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 N LINCOLN AVE STE A
YORK NE
68467-1072
US

IV. Provider business mailing address

2114 N LINCOLN AVENUE SUITE A
YORK NE
68467-1028
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-5555
  • Fax:
Mailing address:
  • Phone: 402-362-5555
  • Fax: 402-362-7137

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: KITTI NIENHUESER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 402-362-0615