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General NPI Number Information
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NPI Number | 1417167370
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Entity Type | Organization
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Legal Business Name | CHADRON MEDICAL CLINIC PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 825 CENTENNIAL DR
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City | CHADRON
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State | NE
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Zip | 69337-9400
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Country | US
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Telephone | 308-432-4441
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Fax | 308-432-4446
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Provider Business Mailing Address
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Address Line | 825 CENTENNIAL DR PO BOX 431
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City | CHADRON
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State | NE
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Zip | 69337-9400
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Country | US
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Telephone | 308-432-4441
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Fax | 308-432-4446
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TERESA J LANDRETH
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Credential |
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Telephone | 308-432-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | NE
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