Provider Demographics
NPI:1942228820
Name:PHYSICIAN HOMECARE ASSOCIATES
Entity Type:Organization
Organization Name:PHYSICIAN HOMECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILLYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-639-6660
Mailing Address - Street 1:51 GINGER WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-9404
Mailing Address - Country:US
Mailing Address - Phone:402-639-6660
Mailing Address - Fax:402-359-2852
Practice Address - Street 1:51 GINGER WOODS RD
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:NE
Practice Address - Zip Code:68064-9404
Practice Address - Country:US
Practice Address - Phone:402-639-6660
Practice Address - Fax:402-359-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21349207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0573758Medicaid
NE10025108500Medicaid
NE099442Medicare ID - Type UnspecifiedGROUP NUMBER
IAI15820Medicare ID - Type UnspecifiedGROUP NUMBER