Provider Demographics
NPI:1972796845
Name:J KEVIN BELVILLE, MD PC
Entity type:Organization
Organization Name:J KEVIN BELVILLE, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHALMOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BELVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-462-9191
Mailing Address - Street 1:1414 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3742
Mailing Address - Country:US
Mailing Address - Phone:402-462-9191
Mailing Address - Fax:402-462-9192
Practice Address - Street 1:1414 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3742
Practice Address - Country:US
Practice Address - Phone:402-462-9191
Practice Address - Fax:402-462-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE138365156FX1800X
NE14789207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025428000Medicaid
KS200410430AMedicaid
KS200410430AMedicaid
NE6041950001Medicare NSC