| |
1120 Grand Ave Humboldt NE 68376-6019 | |
(402) 862-3280 | |
(402) 862-3284 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1120 Grand Ave, Humboldt, Nebraska |
Authorized Official Name and Position | Ryan C Larsen (CEO) |
Authorized Official Contact | 4022452428 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 399 Falls City NE 68355-0399 Ph: (402) 245-4475 | 1120 Grand Ave Humboldt NE 68376-6019 Ph: (402) 862-3280 |
NPI Number | 1851348544 |
---|---|
Provider Enumeration Date | 05/28/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 6608776943 |
---|---|
Medicare Enrollment ID | O20050308000278 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851348544 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |