Provider Demographics
NPI:1225167885
Name:MINDEN FAMILY PRACTICE CLINIC
Entity Type:Organization
Organization Name:MINDEN FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:308-832-0330
Mailing Address - Street 1:345 N MINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1657
Mailing Address - Country:US
Mailing Address - Phone:308-832-0330
Mailing Address - Fax:308-832-0306
Practice Address - Street 1:345 NORTH MINDEN AVENUE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959
Practice Address - Country:US
Practice Address - Phone:308-832-0330
Practice Address - Fax:308-832-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110087261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN283862Medicare Oscar/Certification
NE099722Medicare PIN