Provider Demographics
NPI:1124559901
Name:MERRICK MEDICAL CENTER
Entity Type:Organization
Organization Name:MERRICK MEDICAL CENTER
Other - Org Name:FULLERTON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-946-3015
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-0417
Mailing Address - Country:US
Mailing Address - Phone:308-946-3015
Mailing Address - Fax:308-946-5914
Practice Address - Street 1:901 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3151
Practice Address - Country:US
Practice Address - Phone:308-536-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERRICK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-23
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty