Healthcare Provider Details

I. General information

NPI: 1639206147
Provider Name (Legal Business Name): PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 PIONEER WOODS DR SUITE 1
LINCOLN NE
68506-7551
US

IV. Provider business mailing address

4130 PIONEER WOODS DR STE 1
LINCOLN NE
68506-7552
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-4700
  • Fax:
Mailing address:
  • Phone: 402-489-4700
  • Fax: 402-489-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19446
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1739
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK T HURLBUT
Title or Position: PHYSICIAN-OWNER
Credential: MD
Phone: 402-489-4700