Provider Demographics
NPI:1639132350
Name:BAUGOUS, NANCY T (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:BAUGOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N COTNER BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505
Mailing Address - Country:US
Mailing Address - Phone:402-467-4661
Mailing Address - Fax:402-467-5006
Practice Address - Street 1:770 N COTNER BLVD
Practice Address - Street 2:STE 205
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2310
Practice Address - Country:US
Practice Address - Phone:402-467-4661
Practice Address - Fax:402-467-5006
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054632400Medicaid
NE00227OtherBCBS PROVIDER ID
NE080050300OtherRAILROAD MC PROVIDER ID
NE18271OtherNEBRASKA STATE LICENSE
NE18271OtherNEBRASKA STATE LICENSE
NEE28105Medicare UPIN
NEBT1869253OtherDEA NUMBER