Healthcare Provider Details

I. General information

NPI: 1447253067
Provider Name (Legal Business Name): HASTINGS INTERNAL MEDICINE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 N KANSAS AVE STE 105
HASTINGS NE
68901-2640
US

IV. Provider business mailing address

2115 N KANSAS AVE STE 105
HASTINGS NE
68901-2640
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2454
  • Fax: 402-463-2450
Mailing address:
  • Phone: 402-463-2454
  • Fax: 402-463-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODI SHUCK
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-463-2454