Organization
PHYSICIANS CLINIC, INC.
Active
Other names
Methodist Physicians Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD D. GRAGES (PRESIDENT)
(402) 354-5601
Entity
Organization
Contact information
Practice address
1400 SENATE AVE, SUITE # 105, RED OAK, IA 51566-1271
(712) 623-7250
(712) 623-7257
Mailing address
8601 W DODGE RD, SUITE # 216, OMAHA, NE 68114-3457
(402) 354-4822
(402) 354-5454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0415257
—
IA
01
—
42585
BCBS-IA
IA
Enumeration date
07/10/2007
Last updated
08/22/2020
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