Organization
COLGLAZIER CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFFORD R. COLGLAZIER M.D. (OWNER)
(308) 352-2122
Entity
Organization
Contact information
Practice address
945 WASHINGTON AVENUE, GRANT, NE 69140-0097
(308) 352-2122
(308) 352-2281
Mailing address
945 WASHINGTON AVENUE, PO BOX 97, GRANT, NE 69140-0097
(308) 352-2122
(308) 352-2281
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
14390
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2717
BLUE CROSS
NE
Enumeration date
09/25/2006
Last updated
05/28/2008
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