| Organization Name: | BLOOMFIELD MEDICAL CLINIC, PC |
| NPI Number: | 1003091497 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN D LAUCK (PRESIDENT) |
| Mailing Address: | 105 S Broadway Avenue Bloomfield |
| State: | NE US |
| Postal Code: | 687180357 |
| Phone Number: | 4023734341 |
| Fax Number: | 4023734344 |
| NPI Enumeration Date: | 01/03/2008 |
| NPI Last Update Date: | 03/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 110153 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |