MEDICARE: CHARLES F DAMICO MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	11846	NE

General Provider Information

NPI Number	:	1124221627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES F DAMICO MD PC

Provider Business Mailing Address
First Line	:	208 S BURLINGTON AVE
Second Line	:	SUITE 115
City	:	HASTINGS
State	:	NE
Zip	:	68901-5904
Country	:	US
Telephone Number	:	402-463-2111
Fax Number	:	402-463-2131

Provider Business Practice Location Address
First Line	:	1401 E H ST
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-3432
Country	:	US
Telephone Number	:	308-345-3074
Fax Number	:	308-345-1190

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. CHARLES F DAMICO
Credential	:	MD
Telephone Number	:	402-463-2111

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	08/22/2020

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