Provider Demographics
NPI:1972703023
Name:DELWYN J NAGENGAST MD OFFICE
Entity Type:Organization
Organization Name:DELWYN J NAGENGAST MD OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELWYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAGENGAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-373-4341
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:110 EAST MAIN ST
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718
Mailing Address - Country:US
Mailing Address - Phone:402-373-4311
Mailing Address - Fax:403-373-4344
Practice Address - Street 1:110 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718
Practice Address - Country:US
Practice Address - Phone:402-373-4311
Practice Address - Fax:403-373-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9951207Q00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========12Medicaid
NE099501Medicare ID - Type Unspecified
B67448Medicare UPIN
NE=========12Medicaid