Healthcare Provider Details

I. General information

NPI: 1942228820
Provider Name (Legal Business Name): PHYSICIAN HOMECARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 GINGER WOODS RD
VALLEY NE
68064-9404
US

IV. Provider business mailing address

51 GINGER WOODS RD
VALLEY NE
68064-9404
US

V. Phone/Fax

Practice location:
  • Phone: 402-639-6660
  • Fax: 402-359-2852
Mailing address:
  • Phone: 402-639-6660
  • Fax: 402-359-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number21349
License Number StateNE

VIII. Authorized Official

Name: BERNARD C HILLYER
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 402-639-6660