Provider Demographics
NPI:1083632533
Name:AINSWORTH FAMILY CLINIC, P.C.
Entity Type:Organization
Organization Name:AINSWORTH FAMILY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CAMPBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:402-387-1900
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-0287
Mailing Address - Country:US
Mailing Address - Phone:402-387-1900
Mailing Address - Fax:402-387-0139
Practice Address - Street 1:913 E. ZERO ST.
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-0287
Practice Address - Country:US
Practice Address - Phone:402-387-1900
Practice Address - Fax:402-387-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE095042Medicare PIN