Healthcare Provider Details

I. General information

NPI: 1679623516
Provider Name (Legal Business Name): THE PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S 40TH ST SUITE 101
LINCOLN NE
68506-2424
US

IV. Provider business mailing address

8055 'O' ST STE 300
LINCOLN NE
68510-2580
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-3333
  • Fax: 402-486-3349
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