Provider Demographics
NPI:1336290972
Name:MCCOOK CLINIC, P.C.
Entity Type:Organization
Organization Name:MCCOOK CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROKUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-344-4110
Mailing Address - Street 1:1401 E H ST
Mailing Address - Street 2:PO BOX 1207
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3589
Mailing Address - Country:US
Mailing Address - Phone:308-344-4110
Mailing Address - Fax:308-344-8369
Practice Address - Street 1:1401 E H ST
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3432
Practice Address - Country:US
Practice Address - Phone:308-344-4110
Practice Address - Fax:308-344-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========12Medicaid