# GRAND ISLAND CLINIC INC

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

## Provider details

- **NPI number:** 1598766735
- **Authorized official:** MR. DOUGLAS J HERBEK M.D. (PHYSICIAN)
- **Authorized official phone:** (308) 382-1100

## Contact information

- **Practice address:** 2444 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4327
- **Practice address phone:** (130) 838-2110
- **Practice address fax:** (308) 385-0796
- **Mailing address:** PO BOX 550, GRAND ISLAND, NE 68802-0550
- **Mailing address phone:** (308) 382-1100
- **Mailing address fax:** (308) 385-0796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |

## Other

- **Enumeration date:** 08/10/2005
- **Last updated:** 07/30/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10028822400 | — | NE |
| 01 | — | CO4245 | PALMETTO GBA | NE |