MEDICARE: DR. GORDON JAMES HRNICEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	12545	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01708	OTHER	NE	BCBS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053319046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON JAMES HRNICEK M.D.

Provider Business Mailing Address
First Line	:	1049 GRANITE WAY
Second Line	:
City	:	ASHLAND
State	:	NE
Zip	:	68003-6202
Country	:	US
Telephone Number	:	402-944-4173
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 GRANITE WAY
Second Line	:
City	:	ASHLAND
State	:	NE
Zip	:	68003-6202
Country	:	US
Telephone Number	:	402-944-4173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/26/2012

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