Provider Demographics
NPI:1881919983
Name:R. SAMUEL BRYANT MD PC
Entity type:Organization
Organization Name:R. SAMUEL BRYANT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-484-7001
Mailing Address - Street 1:7001 A ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4205
Mailing Address - Country:US
Mailing Address - Phone:402-484-7001
Mailing Address - Fax:402-484-7006
Practice Address - Street 1:7001 A ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4205
Practice Address - Country:US
Practice Address - Phone:402-484-7001
Practice Address - Fax:402-484-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17600208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025893600Medicaid
NE10025893600Medicaid
NENA1609Medicare PIN