MEDICARE: MIDWEST OB/GYN CLINIC, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	111N00000X	Chiropractor
2	207V00000X	Obstetrics & Gynecology Physician
3	208000000X	Pediatrics Physician
4	213E00000X	Podiatrist
5	363A00000X	Physician Assistant
6	363LW0102X	Women's Health Nurse Practitioner
7	367A00000X	Advanced Practice Midwife
8	207Q00000X	Family Medicine Physician
9	291U00000X	Clinical Medical Laboratory	NE

General Provider Information

NPI Number	:	1538189857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST OB/GYN CLINIC, PC

Provider Business Mailing Address
First Line	:	PO BOX 209
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68702-0209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 N 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-379-2322
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA PROFFITT
Credential	:
Telephone Number	:	402-379-2322

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/10/2008

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