Provider Demographics
NPI:1689062895
Name:GOOD HANDS CLINIC PC
Entity type:Organization
Organization Name:GOOD HANDS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-675-2255
Mailing Address - Street 1:524 SOUTH WEBB RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:308-675-2255
Mailing Address - Fax:308-675-2348
Practice Address - Street 1:524 SOUTH WEBB RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-675-2255
Practice Address - Fax:308-675-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherGENERAL MEDICINE
NE=========OtherCLINIC/CENTER