Healthcare Provider Details

I. General information

NPI: 1669033874
Provider Name (Legal Business Name): BRENT J MORAVEC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N KANSAS AVE STE 202
HASTINGS NE
68901-4438
US

IV. Provider business mailing address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 402-460-5570
  • Fax:
Mailing address:
  • Phone: 402-463-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31941
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8479
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number94-11793
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: