=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700979705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT WESLEY HUGHES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 05/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 CAPEHART RD
-----------------------------------------------------
City | OFFUTT AFB
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68113-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-232-8647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 VALENTINE LN
-----------------------------------------------------
City | PAPILLION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68046-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-557-6144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5490
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------