Healthcare Provider Details

I. General information

NPI: 1780633610
Provider Name (Legal Business Name): TIMOTHY C GOVAERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3563 PRAIRIEVIEW ST
GRAND ISLAND NE
68803-4419
US

IV. Provider business mailing address

PO BOX 860876
MINNEAPOLIS MN
55486-0876
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-2010
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR.0052036
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number12924A
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number19063
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: