Provider Demographics
NPI:1225125057
Name:PHYSICIANS CLINIC, INC.
Entity Type:Organization
Organization Name:PHYSICIANS CLINIC, INC.
Other - Org Name:METHODIST PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-354-5601
Mailing Address - Street 1:8601 WEST DODGE ROAD
Mailing Address - Street 2:SUITE # 216
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-354-4822
Mailing Address - Fax:402-354-5454
Practice Address - Street 1:3353 L STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107
Practice Address - Country:US
Practice Address - Phone:402-354-7700
Practice Address - Fax:402-354-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0561160018Medicare ID - Type Unspecified