Provider Demographics
NPI:1043200462
Name:BEATRICE MEDICAL CENTER PC
Entity Type:Organization
Organization Name:BEATRICE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LANGVARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP FACPE
Authorized Official - Phone:402-228-3366
Mailing Address - Street 1:805 W COURT ST
Mailing Address - Street 2:P. O. BOX 578
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3525
Mailing Address - Country:US
Mailing Address - Phone:402-228-3366
Mailing Address - Fax:402-228-3502
Practice Address - Street 1:805 W COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3525
Practice Address - Country:US
Practice Address - Phone:402-228-3366
Practice Address - Fax:402-228-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12760207Q00000X
NE15796207Q00000X
NE20597207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE0319400001Medicare NSC
NE=========00Medicaid
096432BEMedicare ID - Type Unspecified