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222 S Main St Box 454 Madison NE 68748-6485 | |
| (402) 454-3304 | |
| (402) 454-2567 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 222 S Main St, Madison, Nebraska |
| Authorized Official Name and Position | Kathy Nordby (CHIEF EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4023701060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
302 W Phillip Ave Norfolk NE 68701-5248 Ph: (402) 371-8000 | 222 S Main St Box 454 Madison NE 68748-6485 Ph: (402) 454-3304 |
| NPI Number | 1740516764 |
|---|---|
| Provider Enumeration Date | 10/27/2009 |
| Last Update Date | 07/09/2020 |
| Certification Date | 07/09/2020 |
| Medicare PECOS PAC ID | 9133110182 |
|---|---|
| Medicare Enrollment ID | O20100115000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740516764 | NPI | - | NPPES |
| 10025716900 | Other | NE | MEDICAID FQHC |
| 10025716400 | Medicaid | NE |