MEDICARE: THE PHYSICIAN NETWORK

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
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1164577730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PHYSICIAN NETWORK

Provider Business Mailing Address
First Line	:	2000 Q ST
Second Line	:	SUITE 500
City	:	LINCOLN
State	:	NE
Zip	:	68503-3609
Country	:	US
Telephone Number	:	402-421-0896
Fax Number	:	402-421-0945

Provider Business Practice Location Address
First Line	:	5000 N 26TH ST
Second Line	:	SUITE 400
City	:	LINCOLN
State	:	NE
Zip	:	68521-4749
Country	:	US
Telephone Number	:	402-742-8410
Fax Number	:	402-742-8411

Authorized Official
Title or Position	:	CEO
Name	:	REX K RECKEWEY
Credential	:	MD
Telephone Number	:	402-421-0896

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	03/12/2012

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Directions to “THE PHYSICIAN NETWORK ” Practice Location

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