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NPI Code Detail

MEDICARE: SARA G FILL PA-C

MEDICARE: SARA G FILL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant1006NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1244457OTHERNEMIDLANDS CHOICE CCH
2278972OTHERNECOVENTRY CCH
338734OTHERNEBCBS NE CCH

General Provider Information

NPI Number : 1104920461
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA G FILL PA-C
Provider Business Mailing Address
First Line : 8055 O ST
Second Line : STE 300
City : LINCOLN
State : NE
Zip : 68510-2580
Country : US
Telephone Number : 402-421-0896
Fax Number : 402-421-0945
Provider Business Practice Location Address
First Line : 2116 W FAIDLEY AVE
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-4645
Country : US
Telephone Number : 308-398-5560
Fax Number : 308-398-5306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2006
Last Update Date : 02/28/2008

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Directions to “ SARA G FILL PA-C” Practice Location

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