=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972553584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY DANIEL BABBITT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 03/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W NORFOLK AVE
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68701-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-644-7543
-----------------------------------------------------
Fax | 402-644-7503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 W NORFOLK AVE
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68701-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-644-7543
-----------------------------------------------------
Fax | 402-644-7503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 23039
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------