MEDICARE: SKIN PC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1801277801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIN PC

Provider Business Mailing Address
First Line	:	1935 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5489
Country	:	US
Telephone Number	:	402-727-7979
Fax Number	:	402-727-9306

Provider Business Practice Location Address
First Line	:	1935 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5489
Country	:	US
Telephone Number	:	402-727-7979
Fax Number	:	402-727-9306

Authorized Official
Title or Position	:	OWNER
Name	:	CHAD HILLYER
Credential	:	PA-C
Telephone Number	:	402-727-7979

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/15/2015

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Directions to “SKIN PC ” Practice Location

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