Organization
FAMILY AND SPORT MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD E MATZKE JR. M.D. (OWNER)
(308) 537-7131
Entity
Organization
Contact information
Practice address
918 20TH STREET, GOTHENBURG, NE 69138-1237
(308) 537-7131
(308) 537-7310
Mailing address
918 20TH STREET, GOTHENBURG, NE 69138-1237
(308) 537-7131
(308) 537-7310
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
16542
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026082600
—
NE
Enumeration date
09/02/2006
Last updated
04/30/2012
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