Provider Demographics
NPI:1104868496
Name:PLUM CREEK MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:PLUM CREEK MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-324-6386
Mailing Address - Street 1:1103 BUFFALO BND
Mailing Address - Street 2:PO BOX 797
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1528
Mailing Address - Country:US
Mailing Address - Phone:308-324-6386
Mailing Address - Fax:308-324-6913
Practice Address - Street 1:1103 BUFFALO BND
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1528
Practice Address - Country:US
Practice Address - Phone:308-324-6386
Practice Address - Fax:308-324-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01950OtherBLUE CROSS/BLUE SHIELD NE
NE=========13Medicaid
NE0659310001Medicare NSC
NE092657Medicare ID - Type Unspecified