Healthcare Provider Details

I. General information

NPI: 1083205512
Provider Name (Legal Business Name): BRYAN PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 A ST STE 400
LINCOLN NE
68510-4970
US

IV. Provider business mailing address

2222 S 16TH ST STE 400A
LINCOLN NE
68502-3785
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-4485
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MANGIAMELI JR.
Title or Position: PRESIDENT
Credential:
Phone: 402-481-5603