Organization · Type 2 NPI
Ivy Street Medical LLC
Rural Health Clinic/Center · Stanton, NE
NPI number
1487806147
Active
Practice location
902 Ivy St
Stanton, NE 68779-2348
Fax (402) 439-5502
Mailing address
PO Box 47
Stanton, NE 68779-0047
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Rural Health Clinic/Center Primary | 261QR1300X | None listed |
Rural Health Clinic/Center: Definition to come...
About NPI 1487806147
Ivy Street Medical LLC's National Provider Identifier is 1487806147, issued on Oct 14, 2008. The primary taxonomy on file is Rural Health Clinic/Center (261QR1300X), and the practice location is in Stanton, NE. The record was last updated on Oct 14, 2008.