Provider Demographics
NPI:1609043496
Name:FRIEND MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:FRIEND MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-947-2021
Mailing Address - Street 1:1210 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRIEND
Mailing Address - State:NE
Mailing Address - Zip Code:68359-1116
Mailing Address - Country:US
Mailing Address - Phone:402-947-2021
Mailing Address - Fax:402-947-2127
Practice Address - Street 1:1210 2ND ST
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1116
Practice Address - Country:US
Practice Address - Phone:402-947-2021
Practice Address - Fax:402-947-2127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIEND MEDICAL CENTER, RHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-12
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15963261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1609043496Medicaid