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General NPI Number Information
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NPI Number | 1528151651
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Entity Type | Organization
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Legal Business Name | BROKEN BOW CLINIC PC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 805 SOUTH F STREET
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City | BROKEN BOW
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State | NE
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Zip | 68822-0647
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Country | US
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Telephone | 308-872-6456
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Fax | 308-872-6040
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Provider Business Mailing Address
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Address Line | 805 SOUTH F STREET PO BOX 647
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City | BROKEN BOW
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State | NE
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Zip | 68822-0647
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Country | US
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Telephone | 308-872-6456
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Fax | 308-872-6040
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | MRS. SHAWN S LAWRENCE
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Credential | MD
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Telephone | 308-872-6456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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