1790887917 NPI number — MR. ROYCE LYDELL HIEBNER DC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790887917 NPI number — MR. ROYCE LYDELL HIEBNER DC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HIEBNER

Provider First Name:

ROYCE

Provider Middle Name:

LYDELL

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

DC

Provider Gender Code:

M

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:

1790887917

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/04/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

815 LAKE AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GOTHENBURG

Provider Business Mailing Address State Name:

NE

Provider Business Mailing Address Postal Code:

69138-1943

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

308-537-3691

Provider Business Mailing Address Fax Number:

308-537-3062

Provider First Line Business Practice Location Address:

417 9TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GOTHENBURG

Provider Business Practice Location Address State Name:

NE

Provider Business Practice Location Address Postal Code:

69138

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

308-537-3691

Provider Business Practice Location Address Fax Number:

308-537-3691

Provider Enumeration Date:

09/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 111N00000X , with the licence number:  1061 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 350093505 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 87043 . This is a "FIRST HEALTH DIRECT" identifier . This identifiers is of the category "OTHER".
• Identifier: 9812 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 47081586300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 71079 . This is a "PIONEER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 11576 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 60054 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 62308 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 87042 . This is a "UPREHS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 37257 . This is a "EMPLOYEE BENEFIT CON" identifier . This identifiers is of the category "OTHER".
• Identifier: 87726 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 62308 . This is a "CARE MARK INC" identifier . This identifiers is of the category "OTHER".