Provider Demographics
NPI:1114397254
Name:PRIMARYCARE HOUSECALLS PC
Entity Type:Organization
Organization Name:PRIMARYCARE HOUSECALLS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BACHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-238-4844
Mailing Address - Street 1:322 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4139
Mailing Address - Country:US
Mailing Address - Phone:507-238-4844
Mailing Address - Fax:
Practice Address - Street 1:5601 S 59TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2306
Practice Address - Country:US
Practice Address - Phone:507-238-4844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE123OtherAPPLYING FOR THESE