Provider Demographics
NPI:1720606932
Name:PHYSICIANS CLINIC INC
Entity Type:Organization
Organization Name:PHYSICIANS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-354-5451
Mailing Address - Street 1:825 S 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-9300
Mailing Address - Country:US
Mailing Address - Phone:402-354-5451
Mailing Address - Fax:402-354-5454
Practice Address - Street 1:9850 NICHOLAS ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2191
Practice Address - Country:US
Practice Address - Phone:402-343-1122
Practice Address - Fax:402-343-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical