Provider Demographics
NPI:1467976308
Name:BRYAN HEALTH CONNECT
Entity Type:Organization
Organization Name:BRYAN HEALTH CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DWAINE
Authorized Official - Last Name:GANYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-483-8893
Mailing Address - Street 1:2300 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3704
Mailing Address - Country:US
Mailing Address - Phone:402-483-8891
Mailing Address - Fax:402-483-8896
Practice Address - Street 1:2300 S 16TH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-483-8891
Practice Address - Fax:402-483-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization