Provider Demographics
NPI:1447385851
Name:JOHNSON COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:JOHNSON COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHUEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-335-3371
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0060
Mailing Address - Country:US
Mailing Address - Phone:402-335-3371
Mailing Address - Fax:402-335-3447
Practice Address - Street 1:292 BROADWAY ST.
Practice Address - Street 2:BOX 60
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450
Practice Address - Country:US
Practice Address - Phone:402-335-3371
Practice Address - Fax:402-335-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE0086443Medicare ID - Type Unspecified