Basic Information
| Provider Information | |||||||||
| NPI: | 1043200462 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEATRICE MEDICAL CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 W COURT ST | ||||||||
| Address2: | P. O. BOX 578 | ||||||||
| City: | BEATRICE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 683103525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022283366 | ||||||||
| FaxNumber: | 4022283502 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | BEATRICE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 683103525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022283366 | ||||||||
| FaxNumber: | 4022283502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 09/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | LANGVARDT | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4022283366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD FACP FACPE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 207Q00000X | 15796 | NE | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20597 | NE | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 12760 | NE | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.