PHYSICIANS CLINIC INC

Provider Demographics

• NPI: 1821049156
• Name: PHYSICIANS CLINIC INC
• Entity Type: Organization
• Organization Name: PHYSICIANS CLINIC INC
• Other - Org Name: METHODIST PHYSICIANS CLINIC
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: TODD
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: GRAGES
• Authorized Official - Phone: 402-354-5601
• Mailing Address - Street 1: 825 S 169TH ST
• Mailing Address - City: OMAHA
• Mailing Address - State: NE
• Mailing Address - Zip Code: 68118-9300
• Mailing Address - Country: US
• Practice Address - Street 1: 10060 REGENCY CIR
• Practice Address - City: OMAHA
• Practice Address - State: NE
• Practice Address - Zip Code: 68114-3732
• Practice Address - Country: US
• Practice Address - Phone: 402-354-1500
• Practice Address - Fax: 402-354-5621
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-12
• Last Update Date: 2023-10-09

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207N00000X	Allopathic & Osteopathic Physicians	Dermatology		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RI0200X	Allopathic & Osteopathic Physicians	Internal Medicine	Infectious Disease	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	367A00000X	Physician Assistants & Advanced Practice Nursing Providers	Advanced Practice Midwife		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IA	0256792	Medicaid
NE	=========19	Medicaid
NE	=========98	Medicaid
NE	=========99	Medicaid
NE	=========20	Medicaid
NE	=========85	Medicaid
NE	=========95	Medicaid
NE	=========06	Medicaid
NE	=========62	Medicaid
IA	0256792	Medicaid
NE	=========27	Medicaid
NE	=========46	Medicaid
NE	=========97	Medicaid
NE	=========42	Medicaid
NE	=========61	Medicaid
NE	=========20	Medicaid
IA	51711	Medicare ID - Type Unspecified	PCI RISON SON
NE	=========95	Medicaid
NE	=========97	Medicaid
NE	=========19	Medicaid