Provider Demographics
NPI:1639206147
Name:PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.
Entity type:Organization
Organization Name:PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HURLBUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-489-4700
Mailing Address - Street 1:4130 PIONEER WOODS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7552
Mailing Address - Country:US
Mailing Address - Phone:402-489-4700
Mailing Address - Fax:402-489-5220
Practice Address - Street 1:4130 PIONEER WOODS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7551
Practice Address - Country:US
Practice Address - Phone:402-489-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1739225100000X
332B00000X
NE19446207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025490400Medicaid
DG0311OtherRRM
612249600OtherDOL/ACS WORKERS COMP
612249600OtherDOL/ACS WORKERS COMP
DG0311OtherRRM