Provider Demographics
NPI:1225063266
Name:COUNTRY CLINICS PC
Entity Type:Organization
Organization Name:COUNTRY CLINICS PC
Other - Org Name:ST EDWARD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TROYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-678-2232
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:
Mailing Address - City:ST EDWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68660-0167
Mailing Address - Country:US
Mailing Address - Phone:402-678-2232
Mailing Address - Fax:402-678-2234
Practice Address - Street 1:1102 WATER ST
Practice Address - Street 2:
Practice Address - City:ST EDWARD
Practice Address - State:NE
Practice Address - Zip Code:68660-0167
Practice Address - Country:US
Practice Address - Phone:402-678-2232
Practice Address - Fax:402-678-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28D0455470261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025570200Medicaid
NE=========13Medicaid
NE10025570200Medicaid
099013Medicare ID - Type Unspecified