1679528798 NPI number — BRYAN PHYSICIAN NETWORK

Table of content: (NPI 1679528798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679528798 NPI number — BRYAN PHYSICIAN NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYAN PHYSICIAN NETWORK
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:
1679528798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 S 16TH ST
Provider Second Line Business Mailing Address:
SUITE 400A
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68502-3796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-483-8590
Provider Business Mailing Address Fax Number:
402-483-8599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 S 16TH ST
Provider Second Line Business Practice Location Address:
SUITE 400A
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68502-3796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-483-8590
Provider Business Practice Location Address Fax Number:
402-483-8599
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANGIAMELI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-481-5603

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10025382000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025392200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025636100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025136400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025718000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025896400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026418100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025481300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026454500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026311700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026416000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026464400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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