Park Street Medical Clinic | |
505 S Park St Genoa NE 68640-3036 | |
(402) 993-2205 | |
(402) 993-2595 |
Full Name | Park Street Medical Clinic |
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Speciality | Clinic/Center |
Location | 505 S Park St, Genoa, Nebraska |
Authorized Official Name and Position | Amanda Roebuck (CEO) |
Authorized Official Contact | 4029934583 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Park Street Medical Clinic Po Box 425 Genoa NE 68640-0425 Ph: (402) 993-2206 | Park Street Medical Clinic 505 S Park St Genoa NE 68640-3036 Ph: (402) 993-2205 |
NPI Number | 1720505522 |
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Provider Enumeration Date | 08/23/2017 |
Last Update Date | 01/23/2020 |
Medicare PECOS PAC ID | 5193702777 |
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Medicare Enrollment ID | O20171023002157 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720505522 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
City Of Genoa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 505 S Park St, Genoa, NE 68640 Phone: 402-993-2206 Fax: 402-993-2595 | |
Park Street Medical Clinic Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 South Park Street, Genoa, NE 68640 Phone: 402-993-2206 Fax: 402-993-2595 |