Organization
BLOOMFIELD MEDICAL CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN D LAUCK PA-C (PRESIDENT)
(402) 373-4341
Entity
Organization
Contact information
Practice address
105 S BROADWAY AVENUE, BLOOMFIELD, NE 68718-0357
(402) 373-4341
(402) 373-4344
Mailing address
105 S BROADWAY AVENUE, P O BOX 357, BLOOMFIELD, NE 68718-0357
(402) 373-4341
(402) 373-4344
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1040
NE
363LF0000X
Family Nurse Practitioner
110153
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025588500
—
NE
Enumeration date
01/03/2008
Last updated
03/29/2010
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