Provider Demographics
NPI:1568773497
Name:PHYSICIANS CLINIC, INC.
Entity Type:Organization
Organization Name:PHYSICIANS CLINIC, INC.
Other - Org Name:METHODIST PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-354-5609
Mailing Address - Street 1:8601 W DODGE RD STE 216
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3495
Mailing Address - Country:US
Mailing Address - Phone:402-354-5451
Mailing Address - Fax:402-354-5454
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:STE. 311
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-4050
Practice Address - Fax:712-328-1911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty