MEDICARE: GUILLERMO HUERTA MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	17643	NE
2	207R00000X	Internal Medicine Physician	17643	NE
3	207RP1001X	Pulmonary Disease Physician	17643	NE
4	207R00000X	Internal Medicine Physician	25333	IA
5	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25333	IA
6	207RP1001X	Pulmonary Disease Physician	25333	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1144224841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO HUERTA MD

Provider Business Mailing Address
First Line	:	PO BOX 3755
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0755
Country	:	US
Telephone Number	:	402-354-2100
Fax Number	:	402-354-6171

Provider Business Practice Location Address
First Line	:	1120 N 103RD PLZ
Second Line	:	SUITE 102
City	:	OMAHA
State	:	NE
Zip	:	68114-1114
Country	:	US
Telephone Number	:	402-354-0120
Fax Number	:	402-354-0125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/22/2016

8200 DODGE STREET , CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA, NE
68114-4113

Practice Phone: 402-955-6140
Practice Fax: 402-955-3398