# CHADRON MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417167370
- **Authorized official:** TERESA J LANDRETH (OFFICE MANAGER)
- **Authorized official phone:** (308) 432-4441

## Contact information

- **Practice address:** 825 CENTENNIAL DR, CHADRON, NE 69337-9400
- **Practice address phone:** (308) 432-4441
- **Practice address fax:** (308) 432-4446
- **Mailing address:** 825 CENTENNIAL DR, PO BOX 431, CHADRON, NE 69337-9400
- **Mailing address phone:** (308) 432-4441
- **Mailing address fax:** (308) 432-4446

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NE | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01981 | BLUE SHIELD | NE |