Healthcare Provider Details

I. General information

NPI: 1710630322
Provider Name (Legal Business Name): ERIC BIBINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NORMAL BLVD STE 201
LINCOLN NE
68506-5250
US

IV. Provider business mailing address

1123 N 9TH ST
BEATRICE NE
68310-2041
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-4017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: