# BLOOMFIELD MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BLOOMFIELD MEDICAL CLINIC PC
- **Other names:** Bloomfield Medical Clinic DBA Osmond Medical Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902355951
- **Legal business name:** BLOOMFIELD MEDICAL CLINIC PC
- **Authorized official:** KEVIN D LAUCK PA-C (PRESIDENT)
- **Authorized official phone:** (402) 373-4341

## Contact information

- **Practice address:** 418 N STATE ST, OSMOND, NE 68765-5722
- **Practice address phone:** (402) 748-3366
- **Practice address fax:** (402) 373-4344
- **Mailing address:** 105 S BROADWAY ST, PO BOX 357, BLOOMFIELD, NE 68718-4419
- **Mailing address phone:** (402) 373-4341
- **Mailing address fax:** (402) 373-4344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25844 | NE | Yes |
| 363A00000X | Physician Assistant | 1040 | NE | — |
| 363A00000X | Physician Assistant | 2003 | NE | — |
| 363LF0000X | Family Nurse Practitioner | 110153 | NE | — |

## Other

- **Enumeration date:** 09/30/2016
- **Last updated:** 09/30/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025588500 | — | NE |