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NPI Code Detail

MEDICARE: PETER J. THIELE PA-C

MEDICARE: PETER J. THIELE PA-C
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
1363AM0700XMedical Physician Assistant868NE

General Provider Information

NPI Number : 1679689004
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER J. THIELE PA-C
Provider Business Mailing Address
First Line : 430 N MONITOR ST
Second Line :
City : WEST POINT
State : NE
Zip : 68788-1595
Country : US
Telephone Number : 402-372-6717
Fax Number : 402-372-2360
Provider Business Practice Location Address
First Line : 211 N ENGDAHL AVE
Second Line :
City : OAKLAND
State : NE
Zip : 68045-1431
Country : US
Telephone Number : 402-685-5116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/31/2023

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Directions to “ PETER J. THIELE PA-C” Practice Location

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