Healthcare Provider Details

I. General information

NPI: 1639123185
Provider Name (Legal Business Name): FAMILY PRACTICE OF GRAND ISLAND P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3563 PRAIRIEVIEW ST STE 300
GRAND ISLAND NE
68803-4442
US

IV. Provider business mailing address

PO BOX 9802
GRAND ISLAND NE
68802-9802
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-0162
  • Fax: 308-389-4445
Mailing address:
  • Phone: 308-381-0162
  • Fax: 308-389-4445

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEVEN L HUSEN
Title or Position: OWNER
Credential: M.D.
Phone: 308-381-0162