MEDICARE: DR. MARK WILLIAM SERBOUSEK 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	207Q00000X	Family Medicine Physician	17178	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080051714	OTHER	NE	RAILROAD MEDICARE

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
3	4297	OTHER	NE	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841287166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WILLIAM SERBOUSEK M.D.

Provider Business Mailing Address
First Line	:	1401 EAST H STREET
Second Line	:	PO BOX 1207
City	:	MCCOOK
State	:	NE
Zip	:	69001-1207
Country	:	US
Telephone Number	:	308-345-4110
Fax Number	:	308-345-8369

Provider Business Practice Location Address
First Line	:	1401 EAST H STREET
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-1207
Country	:	US
Telephone Number	:	308-344-4110
Fax Number	:	304-344-8369

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	11/17/2009

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