Healthcare Provider Details

I. General information

NPI: 1427042910
Provider Name (Legal Business Name): ROMMIE J HUGHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W 42ND ST SUITE 3100
SCOTTSBLUFF NE
69361-0615
US

IV. Provider business mailing address

2 W 42ND ST SUITE 3100
SCOTTSBLUFF NE
69361-0615
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-2872
  • Fax: 308-632-4191
Mailing address:
  • Phone: 308-632-2872
  • Fax: 308-632-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number21137
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier47070174412
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: