Provider Demographics
NPI:1568942803
Name:CHILDREN & ADOLESEANT CLINIC PC
Entity Type:Organization
Organization Name:CHILDREN & ADOLESEANT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:UTECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-463-6828
Mailing Address - Street 1:2115 N KANSAS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2615
Mailing Address - Country:US
Mailing Address - Phone:402-463-6728
Mailing Address - Fax:402-463-4767
Practice Address - Street 1:2115 N KANSAS AVE STE 103
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2615
Practice Address - Country:US
Practice Address - Phone:402-463-6728
Practice Address - Fax:402-463-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty