Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 315 N C St, Edgar, Nebraska |
Authorized Official Name and Position | Treg Vyzourek (CEO) |
Authorized Official Contact | 4028793281 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 407 Superior NE 68978-0407 Ph: (402) 879-4781 | 315 N C St Edgar NE 68935-3194 Ph: (402) 224-3344 |
NPI Number | 1699746248 |
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Provider Enumeration Date | 01/31/2006 |
Last Update Date | 03/23/2022 |
Medicare PECOS PAC ID | 4082513015 |
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Medicare Enrollment ID | O20170612001904 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699746248 | NPI | - | NPPES |
10025359800 | Medicaid | NE | |
10025288500 | Medicaid | NE |