=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295834968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CARE MEDICAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 09/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2605 2ND AVE
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68847-4425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-236-7016
-----------------------------------------------------
Fax | 308-236-7027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2605 2ND AVE
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68847-4425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-236-7016
-----------------------------------------------------
Fax | 308-236-7027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC ADMINISTRATOR
-----------------------------------------------------
Name | MR. AARON J MADSEN
-----------------------------------------------------
Credential | MBA, ATC, NREMT
-----------------------------------------------------
Telephone | 308-236-7016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------