Provider Demographics
NPI:1700828415
Name:JAEGER, SIDNEY W
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:W
Last Name:JAEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 BUFFALO BND
Mailing Address - Street 2:PO BOX 797
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1528
Mailing Address - Country:US
Mailing Address - Phone:308-324-6386
Mailing Address - Fax:308-324-6913
Practice Address - Street 1:1103 BUFFALO BND
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1528
Practice Address - Country:US
Practice Address - Phone:308-324-6386
Practice Address - Fax:308-324-6913
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47058329013Medicaid
NER81490Medicare UPIN
NE47058329013Medicaid
NE47058329013Medicaid