Provider Demographics
NPI:1861663650
Name:UTICA MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:UTICA MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-534-2851
Mailing Address - Street 1:PO BOX 67250
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7250
Mailing Address - Country:US
Mailing Address - Phone:402-436-2855
Mailing Address - Fax:402-436-2859
Practice Address - Street 1:1350 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NE
Practice Address - Zip Code:68456-6094
Practice Address - Country:US
Practice Address - Phone:402-534-2041
Practice Address - Fax:402-534-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty