Provider Demographics
NPI:1124131032
Name:FAMILY MEDICAL CENTER OF HASTINGS
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTER OF HASTINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:THEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-8456
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0968
Mailing Address - Country:US
Mailing Address - Phone:402-462-8456
Mailing Address - Fax:
Practice Address - Street 1:1021 W 14TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3046
Practice Address - Country:US
Practice Address - Phone:402-463-2423
Practice Address - Fax:402-463-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02842OtherBCBS NE
NECO4191OtherRAILROAD MEDICARE
NE092194Medicare PIN
NE0311840001Medicare NSC