Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207Q00000X | Family Medicine | | 20546 | NEBRASKA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 01-06810 | OTHER | NEBRASKA | UHC - TFH |
| 2 | 8334 | OTHER | | MIDLANDS CHOICE |
| 3 | P00454300 | MEDICARE PIN | | |
| 4 | 01-01285 | OTHER | NEBRASKA | UHC - APC |
| 5 | 01-07692 | OTHER | | UHC - SCF |
| 6 | 470780857 07 | MEDICAID | NEBRASKA | |
| 7 | 28-3855 | MEDICARE PIN | | |
| 8 | 00543 | OTHER | | BCBS |
| 9 | 31789 | OTHER | NEBRASKA | BCBS |
| 10 | G79404 | MEDICARE UPIN | | |
| 11 | 470780857 18 | MEDICAID | NEBRASKA | |
| 12 | 278880 | MEDICARE PIN | | |
| 13 | 100252190 00 | MEDICAID | NEBRASKA | |
| 14 | 100252191 00 | MEDICAID | NEBRASKA | |
| 15 | 281220 | MEDICARE PIN | | |
| 16 | 28-3856 | MEDICARE PIN | | |