MEDICARE: JOHN BECKENHAUER 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
1	363AS0400X	Surgical Physician Assistant	961	NE
2	363A00000X	Physician Assistant	961	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970030785	OTHER	NE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	37830	OTHER	NE	BCBS
4	68154A018	OTHER	NE	TRICARE

General Provider Information

NPI Number	:	1811991789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BECKENHAUER PA-C

Provider Business Mailing Address
First Line	:	988102 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-8102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	EMILE @ 42ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-0001
Country	:	US
Telephone Number	:	402-559-5000
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/09/2021

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Directions to “ JOHN BECKENHAUER PA-C” Practice Location

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