MEDICARE: MR. GARY W BARTH 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	174400000X	Specialist	14009	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00580	OTHER	NE	BLUE CROSS BLUE SHIELD NE

General Provider Information

NPI Number	:	1700888591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY W BARTH MD

Provider Business Mailing Address
First Line	:	2115 N KANSAS AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-2615
Country	:	US
Telephone Number	:	402-462-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 N KANSAS AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-2615
Country	:	US
Telephone Number	:	402-462-5555
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/04/2007

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Directions to “ MR. GARY W BARTH MD” Practice Location

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