Provider Demographics
| NPI: | 1265489157 |
|---|---|
| Name: | FAITH REGIONAL PHYSICIAN SERVICES, LLC |
| Entity Type: | Organization |
| Organization Name: | FAITH REGIONAL PHYSICIAN SERVICES, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BRIAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BLECHER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 402-644-7536 |
| Mailing Address - Street 1: | 110 N 29TH ST |
| Mailing Address - Street 2: | SUITE 201 |
| Mailing Address - City: | NORFOLK |
| Mailing Address - State: | NE |
| Mailing Address - Zip Code: | 68701-4461 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 402-844-8385 |
| Mailing Address - Fax: | 402-844-8122 |
| Practice Address - Street 1: | 110 N 29TH ST |
| Practice Address - Street 2: | SUITE 201 |
| Practice Address - City: | NORFOLK |
| Practice Address - State: | NE |
| Practice Address - Zip Code: | 68701-4461 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 402-844-8385 |
| Practice Address - Fax: | 402-844-8122 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | FAITH REGIONAL HEALTH SERVICES |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-27 |
| Last Update Date: | 2022-06-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NE | 10025153200 | Medicaid | |
| NE | 099588 | Medicare ID - Type Unspecified | |
| NE | NA1140 | Other | MEDICARE |
| NE | DC8332 | Medicare ID - Type Unspecified | RR |
