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General NPI Number Information
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NPI Number | 1093151037
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Entity Type | Organization
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Legal Business Name | 50 PLUS CLINIC, INC.
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 503 E 3RD ST
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City | ALLIANCE
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State | NE
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Zip | 69301-3831
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Country | US
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Telephone | 308-629-1600
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Fax | 308-629-1616
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Provider Business Mailing Address
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Address Line | PO BOX 297
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City | ALLIANCE
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State | NE
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Zip | 69301-0297
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Country | US
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Telephone | 308-629-1600
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Fax | 308-629-1616
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIBETH CONRAD
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Credential | APRN
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Telephone | 308-763-1354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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