Provider Demographics
NPI:1942408117
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 - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-354-5601
Mailing Address - Street 1:8601 W DODGE RD
Mailing Address - Street 2:SUITE # 216
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3457
Mailing Address - Country:US
Mailing Address - Phone:402-354-4822
Mailing Address - Fax:402-354-5454
Practice Address - Street 1:1400 SENATE AVE
Practice Address - Street 2:SUITE # 105
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1271
Practice Address - Country:US
Practice Address - Phone:712-623-7250
Practice Address - Fax:712-623-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0415257Medicaid
IA42585OtherBCBS-IA
IA0415257Medicaid