Healthcare Provider Details

I. General information

NPI: 1295948586
Provider Name (Legal Business Name): FREDERICK D. HATHAWAY, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S 40TH ST SUITE 300
LINCOLN NE
68506-5243
US

IV. Provider business mailing address

PO BOX 6971
LINCOLN NE
68506-0971
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-7073
  • Fax: 402-434-6047
Mailing address:
  • Phone: 402-486-7073
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK D HATHAWAY
Title or Position: OWNER
Credential: MD
Phone: 402-486-7073