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General NPI Number Information
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NPI Number | 1841313566
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Entity Type | Organization
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Legal Business Name | CENTRAL NEBRASKA MEDICAL CLINIC, PC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | CORNER OF JEWETT AND BRIDGE
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City | DUNNING
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State | NE
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Zip | 68833-0000
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Country | US
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Telephone | 308-872-2486
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Fax | 308-872-2027
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Provider Business Mailing Address
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Address Line | 145 MEMORIAL DR
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City | BROKEN BOW
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State | NE
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Zip | 68822-1378
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Country | US
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Telephone | 308-872-2486
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Fax | 308-872-2027
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | DR. DAVID A MINNICK
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Credential | M.D.
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Telephone | 308-872-2486
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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 | NE
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