1235394669 NPI number — BEATRICE PHYSICAL THERAPY & HELATH CLINIC

Table of content: DR. PRYCE TIFFANY GAYNOR M.D. (NPI 1972916955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235394669 NPI number — BEATRICE PHYSICAL THERAPY & HELATH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEATRICE PHYSICAL THERAPY & HELATH CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235394669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 SOUTH 6TH ST
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
BEATRICE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68310-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-228-3711
Provider Business Mailing Address Fax Number:
402-228-3711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 SOUTH 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
BEATRICE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68310-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-228-3711
Provider Business Practice Location Address Fax Number:
402-228-3711
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER AND THERAPIST
Authorized Official Telephone Number:
402-228-3711

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  52 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F233770 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 685456 . This is a "UNITED HELATHCARE ACN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9101 . This is a "BCBS OF NEBR" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 650001946 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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