Provider Demographics
NPI:1689712192
Name:FRIEND MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:FRIEND MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 STREET
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15963261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1689712192Medicaid
NE092587Medicare PIN
NE283846Medicare Oscar/Certification