Provider Demographics
NPI:1992088660
Name:VAN WIE, WILLIAM SCOTT (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:VAN WIE
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 1:50 KUESTER LK
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8609
Mailing Address - Country:US
Mailing Address - Phone:308-384-3457
Mailing Address - Fax:
Practice Address - Street 1:1917 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4642
Practice Address - Country:US
Practice Address - Phone:308-382-5100
Practice Address - Fax:308-382-5155
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026008900Medicaid
NE650150001OtherMEDICARE PTAN