Provider Demographics
NPI:1043413511
Name:DAVID HULT, M.D., P.C.
Entity Type:Organization
Organization Name:DAVID HULT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:HULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-537-7131
Mailing Address - Street 1:918 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1237
Mailing Address - Country:US
Mailing Address - Phone:308-537-7131
Mailing Address - Fax:308-537-7310
Practice Address - Street 1:918 20TH STREET
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1237
Practice Address - Country:US
Practice Address - Phone:308-537-7131
Practice Address - Fax:308-537-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069425800Medicaid
NE04210OtherNEBR BLUE CROSS
NE4391OtherMIDLANDS CHOICE
NE10026082500Medicaid
NE32390OtherBC/BS
NE4391OtherMIDLANDS CHOICE
099977Medicare PIN
NE32390OtherBC/BS