MEDICARE: TIMOTHY CHARLES FITZGIBBONS 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	207X00000X	Orthopaedic Surgery Physician	12962	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09-00179	OTHER	NE	SHARE ADVANTAGE/MERCY RD
3	8012	OTHER	NE	MIDLANDS CHOICE
4	02765	OTHER	NE	BCBS OF NEBRASKA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	09-01136	OTHER	NE	SHARE ADVANTAGE/LAKESIDE

General Provider Information

NPI Number	:	1346281805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY CHARLES FITZGIBBONS M.D.

Provider Business Mailing Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 200
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-399-8550
Fax Number	:	402-399-8455

Provider Business Practice Location Address
First Line	:	7710 MERCY RD
Second Line	:	SUITE 224
City	:	OMAHA
State	:	NE
Zip	:	68124-2372
Country	:	US
Telephone Number	:	402-399-8550
Fax Number	:	402-399-8455

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/29/2023

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