Provider Demographics
NPI:1811192479
Name:MIDWEST COUNTRY CLINIC
Entity Type:Organization
Organization Name:MIDWEST COUNTRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-684-2908
Mailing Address - Street 1:HC 75 BOX 149
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:NE
Mailing Address - Zip Code:68714-9727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 H STREET
Practice Address - Street 2:
Practice Address - City:BURWELL
Practice Address - State:NE
Practice Address - Zip Code:68823
Practice Address - Country:US
Practice Address - Phone:402-684-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty