=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740201771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FILLMORE COUNTY MEDICAL CENTER P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 06/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 F ST
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68361-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-759-4485
-----------------------------------------------------
Fax | 402-759-4487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1840 F ST
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68361-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-759-4485
-----------------------------------------------------
Fax | 402-759-4487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JASON L BESPALEC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 402-759-4485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------