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General NPI Number Information
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NPI Number | 1033210257
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Entity Type | Individual
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Provider Name | RICHARD CHARLES TREADWAY SR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2201 N BROADWELL AVE NWIVAHCS
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City | GRAND ISLAND
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State | NE
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Zip | 68803-2153
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Country | US
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Telephone | 308-382-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 531 MICKEY ST PO BOX 135
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City | OSCEOLA
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State | NE
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Zip | 68651-5519
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Country | US
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Telephone | 402-747-8091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 131
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License Number State | NE
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