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1659371607

NPI Code Detail

MEDICARE: AGNES GOMES MD

MEDICARE: AGNES GOMES MD

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	208000000X	Pediatrics Physician	13219	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5931	OTHER	NE	MIDLANDS CHOICE
2	00819	OTHER	NE	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659371607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES GOMES MD

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68802-0550
Country	:	US
Telephone Number	:	308-382-1100
Fax Number	:	308-385-0796

Provider Business Practice Location Address
First Line	:	2444 W FAIDLEY AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4327
Country	:	US
Telephone Number	:	308-382-1100
Fax Number	:	308-385-0796

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/05/2007

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Directions to “ AGNES GOMES MD” Practice Location

Language	Start Address	Practice Location

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