Provider Demographics
NPI:1932287570
Name:COUNTRY CLINICS, PC
Entity Type:Organization
Organization Name:COUNTRY CLINICS, PC
Other - Org Name:CEDAR RAPIDS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-678-2232
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:NE
Mailing Address - Zip Code:68627-0313
Mailing Address - Country:US
Mailing Address - Phone:308-358-0615
Mailing Address - Fax:308-358-0617
Practice Address - Street 1:106 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:NE
Practice Address - Zip Code:68627
Practice Address - Country:US
Practice Address - Phone:308-358-0615
Practice Address - Fax:308-358-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025570600Medicaid
NE10025570700Medicaid
NE10025570600Medicaid
NE10025570700Medicaid
NE283864Medicare Oscar/Certification