Organization
FAIRBURY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKI MOELLENBERNDT (OFFICE MANAGER)
(402) 729-3361
Entity
Organization
Contact information
Practice address
825 22ND ST, FAIRBURY, NE 68352-1299
(402) 729-3361
(402) 729-4010
Mailing address
825 22ND ST, FAIRBURY, NE 68352-1299
(402) 729-3361
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100300280A
—
KS
05
—
100300280B
—
KS
Enumeration date
01/30/2006
Last updated
10/12/2010
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