NPIMap

Organization Active NPI

Gothenburg Family Practice Rural Health Clinic LLC

  • Clinic/Center
  • Gothenburg, NE
National Provider Identifier
1639401508
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GOTHENBURG FAMILY PRACTICE RURAL HEALTH CLINIC LLC
Practice address
918 20TH Street
Gothenburg, NE 69138-1237
Phone
(308) 537-7131
Fax
(308) 537-7310
NPI assigned
Feb 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gerald E Matzke Jr., M.D.
Title
Partner
Phone
(308) 537-7131

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 10025929400 NE
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

918 20TH Street
Gothenburg, NE 69138-1237

Mailing address

918 20TH Street
Gothenburg, NE 69138-1237
Phone (308) 537-7131

Other identifiers 3

IdentifierTypeStateIssuer
10025929400MedicaidNE
60387OtherNEBC/BS
60387OtherBC/BS

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1639401508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 20TH STREET",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381237",
            "telephone_number": "308-537-7131",
            "fax_number": "308-537-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 20TH STREET",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381237",
            "telephone_number": "308-537-7131",
            "fax_number": "308-537-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOTHENBURG FAMILY PRACTICE RURAL HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "MATZKE",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "308-537-7131",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NE",
            "license": "10025929400",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025929400",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "60387",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "60387",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gothenburg, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.