Provider Demographics
NPI:1457311482
Name:BUTLER COUNTY CLINIC P C
Entity Type:Organization
Organization Name:BUTLER COUNTY CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAVICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-367-3193
Mailing Address - Street 1:336 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-2116
Mailing Address - Country:US
Mailing Address - Phone:402-367-3193
Mailing Address - Fax:402-367-3261
Practice Address - Street 1:336 S 9TH ST
Practice Address - Street 2:
Practice Address - City:DAVID CITY
Practice Address - State:NE
Practice Address - Zip Code:68632-2116
Practice Address - Country:US
Practice Address - Phone:402-367-3193
Practice Address - Fax:402-367-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid
NE093482Medicare PIN
NECD8446Medicare PIN