1508881244 NPI number — DR. PHILLIP R HYNES MD

Table of content: MELISSA ANN KOHNERT LCSW (NPI 1568278232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508881244 NPI number — DR. PHILLIP R HYNES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYNES
Provider First Name:
PHILLIP
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1508881244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6951
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-0951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-904-7135
Provider Business Mailing Address Fax Number:
402-904-7175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 EIGER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-6537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-904-7135
Provider Business Practice Location Address Fax Number:
402-904-7175
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  17831 , 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: 06433 . This is a "BCBS OF NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 77063443668510A003 . This is a "TRI WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236134 . This is a "COVENTRY HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00226772 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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