Provider Demographics
NPI:1740201771
Name:FILLMORE COUNTY MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:FILLMORE COUNTY MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BESPALEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-759-4485
Mailing Address - Street 1:1840 F ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-2211
Mailing Address - Country:US
Mailing Address - Phone:402-759-4485
Mailing Address - Fax:402-759-4487
Practice Address - Street 1:1840 F ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-2211
Practice Address - Country:US
Practice Address - Phone:402-759-4485
Practice Address - Fax:402-759-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025197500Medicaid
NE10025178000Medicaid
NE099608Medicare ID - Type UnspecifiedMEDICARE PART B
NE28-3844Medicare ID - Type UnspecifiedMEDICARE RURAL HEALTH