Organization Name: | BARRETT CLINIC PC |
NPI Number: | 1215340096 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MITCHELL LEE BARRETT (CEO/OWNER/FOUNDER) |
Mailing Address: | 8074 S 84th St La Vista |
State: | NE US |
Postal Code: | 681283303 |
Phone Number: | 4029919500 |
Fax Number: | 4029919564 |
NPI Enumeration Date: | 06/09/2014 |
NPI Last Update Date: | 01/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | 110993 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |