=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992723886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNARD C HILLYER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 08/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 GINGER WOODS RD
-----------------------------------------------------
City | VALLEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68064-9404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-639-6660
-----------------------------------------------------
Fax | 402-359-2852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 GINGER WOODS RD
-----------------------------------------------------
City | VALLEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68064-9404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-639-6660
-----------------------------------------------------
Fax | 402-359-2852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 21349
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 19980
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------