Healthcare Provider Details

I. General information

NPI: 1689169344
Provider Name (Legal Business Name): FAITH REGIONAL PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N 29TH ST STE 201
NORFOLK NE
68701-4461
US

IV. Provider business mailing address

110 N 29TH ST STE 201
NORFOLK NE
68701-4461
US

V. Phone/Fax

Practice location:
  • Phone: 402-844-8385
  • Fax: 402-844-8121
Mailing address:
  • Phone: 402-844-8385
  • Fax: 402-844-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK ROCHE
Title or Position: C.O.O.
Credential:
Phone: 402-844-8121