MEDICARE: THE PHYSICIAN NETWORK

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	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679623516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PHYSICIAN NETWORK

Provider Business Mailing Address
First Line	:	8055 'O' ST
Second Line	:	STE 300
City	:	LINCOLN
State	:	NE
Zip	:	68510-2580
Country	:	US
Telephone Number	:	402-421-0896
Fax Number	:	402-421-0945

Provider Business Practice Location Address
First Line	:	2200 S 40TH ST
Second Line	:	SUITE 101
City	:	LINCOLN
State	:	NE
Zip	:	68506-2424
Country	:	US
Telephone Number	:	402-486-3333
Fax Number	:	402-486-3349

Authorized Official
Title or Position	:	CEO
Name	:	REX K RECKEWEY
Credential	:	MD
Telephone Number	:	402-421-0896

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	02/29/2008

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Directions to “THE PHYSICIAN NETWORK ” Practice Location

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