MEDICARE: DR. JAMES BEREND VAN DELDEN M.D.

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	208D00000X	General Practice Physician	16596	NE

General Provider Information

NPI Number	:	1467477471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BEREND VAN DELDEN M.D.

Provider Business Mailing Address
First Line	:	902 NEBRASKA ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1428
Country	:	US
Telephone Number	:	402-833-5531
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 INDIAN HILLS DRIVE
Second Line	:
City	:	MACY
State	:	NE
Zip	:	68039-0250
Country	:	US
Telephone Number	:	402-837-5381
Fax Number	:	402-837-5303

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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