Provider Demographics
NPI:1699880385
Name:MAHNKE, STEVEN SCOT (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:SCOT
Last Name:MAHNKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-2123
Mailing Address - Country:US
Mailing Address - Phone:308-946-3845
Mailing Address - Fax:
Practice Address - Street 1:2510 18TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-2123
Practice Address - Country:US
Practice Address - Phone:308-946-3845
Practice Address - Fax:308-946-2357
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE080109830OtherRAILROAD MEDICARE
NE30561OtherBLUECROSS BLUESHIELD
NE5072OtherMIDLANDS CHOICE
B90839Medicare UPIN
NE5072OtherMIDLANDS CHOICE