Provider Demographics
NPI:1083788103
Name:MCGILL FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:MCGILL FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYCI
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:402-505-9657
Mailing Address - Street 1:1502 S WASHINGTON ST
Mailing Address - Street 2:STE 201
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3136
Mailing Address - Country:US
Mailing Address - Phone:402-505-9657
Mailing Address - Fax:402-505-9658
Practice Address - Street 1:1502 S WASHINGTON ST
Practice Address - Street 2:STE 201
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3136
Practice Address - Country:US
Practice Address - Phone:402-505-9657
Practice Address - Fax:402-505-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025060800Medicaid
NE099482Medicare ID - Type Unspecified
NEG74597Medicare UPIN