Healthcare Provider Details

I. General information

NPI: 1114007648
Provider Name (Legal Business Name): WILLIAM J PLYMALE JR. PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST SUITE 605
LINCOLN NE
68506-1276
US

IV. Provider business mailing address

901 QUAIL RIDGE CIR
BEATRICE NE
68310-4348
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-7100
  • Fax: 402-489-3249
Mailing address:
  • Phone: 402-223-3051
  • Fax: 402-489-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number150
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: