MEDICARE: BUTLER COUNTY CLINIC P C

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1457311482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTLER COUNTY CLINIC P C

Provider Business Mailing Address
First Line	:	336 S 9TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-2116
Country	:	US
Telephone Number	:	402-367-3193
Fax Number	:	402-367-3261

Provider Business Practice Location Address
First Line	:	336 S 9TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-2116
Country	:	US
Telephone Number	:	402-367-3193
Fax Number	:	402-367-3261

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	TORI J LAVICKY
Credential	:
Telephone Number	:	402-367-3193

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/30/2021

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Directions to “BUTLER COUNTY CLINIC P C ” Practice Location

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