Provider Demographics
NPI:1932342706
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:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-354-5609
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:402-354-5451
Mailing Address - Fax:402-354-5454
Practice Address - Street 1:713 MAIN ST
Practice Address - Street 2:
Practice Address - City:TABOR
Practice Address - State:IA
Practice Address - Zip Code:51653-2031
Practice Address - Country:US
Practice Address - Phone:712-527-5204
Practice Address - Fax:712-527-9346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-09
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0561160022Medicare NSC