Healthcare Provider Details

I. General information

NPI: 1508881244
Provider Name (Legal Business Name): PHILLIP R HYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 EIGER DR
LINCOLN NE
68516-6537
US

IV. Provider business mailing address

PO BOX 6951
LINCOLN NE
68506-0951
US

V. Phone/Fax

Practice location:
  • Phone: 402-904-7135
  • Fax: 402-904-7175
Mailing address:
  • Phone: 402-904-7135
  • Fax: 402-904-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number17831
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: