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General NPI Number Information
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NPI Number | 1619454485
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Entity Type | Organization
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Legal Business Name | HOLDREGE MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 516 W 14TH AVE STE 100
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City | HOLDREGE
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State | NE
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Zip | 68949-1215
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Country | US
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Telephone | 308-995-4431
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Fax |
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Provider Business Mailing Address
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Address Line | 516 W 14TH AVE STE 100
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City | HOLDREGE
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State | NE
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Zip | 68949-1215
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Country | US
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Telephone | 308-995-4431
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Fax |
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Authorized Official
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Title or Position | CREDENTIALS
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Name | SHARON JENSEN
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Credential |
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Telephone | 308-995-2847
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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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