Healthcare Provider Details

I. General information

NPI: 1932153400
Provider Name (Legal Business Name): BELLEVUE FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 LONGO DR SUITE 201
BELLEVUE NE
68005-2977
US

IV. Provider business mailing address

2206 LONGO DR SUITE 201
BELLEVUE NE
68005-2977
US

V. Phone/Fax

Practice location:
  • Phone: 402-292-9170
  • Fax: 402-292-0119
Mailing address:
  • Phone: 402-292-9170
  • Fax: 402-292-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT J SANUIK
Title or Position: PRESIDENT
Credential:
Phone: 402-292-9170