Provider Demographics
NPI:1144364274
Name:MYC PC
Entity type:Organization
Organization Name:MYC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:YIU
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-284-9839
Mailing Address - Street 1:REGIONAL MEDICAL FACILITY
Mailing Address - Street 2:333 EAST 2ND ST.
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153
Mailing Address - Country:US
Mailing Address - Phone:308-284-9839
Mailing Address - Fax:308-284-4120
Practice Address - Street 1:333 E 2ND ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2630
Practice Address - Country:US
Practice Address - Phone:308-284-9839
Practice Address - Fax:308-284-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21559261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care