Provider Demographics
NPI:1225669757
Name:NEXTGEN MALE MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:NEXTGEN MALE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-614-9700
Mailing Address - Street 1:17602 WRIGHT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2097
Mailing Address - Country:US
Mailing Address - Phone:402-614-9700
Mailing Address - Fax:402-359-1751
Practice Address - Street 1:17602 WRIGHT ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2097
Practice Address - Country:US
Practice Address - Phone:402-614-9700
Practice Address - Fax:402-359-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care