Healthcare Provider Details

I. General information

NPI: 1194759019
Provider Name (Legal Business Name): THE PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 70TH ST SUITE 300
LINCOLN NE
68510-2471
US

IV. Provider business mailing address

2000 Q ST SUITE 500
LINCOLN NE
68503-3609
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-7498
  • Fax: 402-219-7327
Mailing address:
  • Phone: 402-421-0896
  • Fax: 402-421-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: REX K RECKEWEY
Title or Position: CEO
Credential: MD
Phone: 402-421-0896