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General NPI Number Information
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NPI Number | 1417138116
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Entity Type | Organization
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Legal Business Name | SURGERY ADULT PEDIATRIC VASCULAR P.C.
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 2115 N KANSAS AVE SUITE 107
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City | HASTINGS
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State | NE
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Zip | 68901-2615
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Country | US
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Telephone | 402-462-2330
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 249 SUITE 107
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City | HASTINGS
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State | NE
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Zip | 68902-0249
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Country | US
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Telephone | 402-462-2330
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY W BARTH
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Credential | MD
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Telephone | 402-462-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 14009
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License Number State | NE
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