Provider Demographics
NPI:1902825904
Name:HILLYER, CHAD MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:HILLYER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 VETERANS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-6912
Mailing Address - Country:US
Mailing Address - Phone:402-916-5665
Mailing Address - Fax:402-934-2719
Practice Address - Street 1:1408 VETERANS DR
Practice Address - Street 2:STE 100
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-6912
Practice Address - Country:US
Practice Address - Phone:402-916-5665
Practice Address - Fax:402-934-2719
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1041207N00000X, 207N00000X
IA001538207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP01022462OtherRR MEDICARE
NENA1899Medicare PIN
NEP01022462OtherRR MEDICARE
NE277157Medicare PIN
NE10026009100Medicaid
NENA1899001Medicare PIN
NENA1899Medicare PIN