Provider Demographics
NPI:1447253067
Name:HASTINGS INTERNAL MEDICINE ASSOCIATES PC
Entity type:Organization
Organization Name:HASTINGS INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-463-2454
Mailing Address - Street 1:2115 N KANSAS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2640
Mailing Address - Country:US
Mailing Address - Phone:402-463-2454
Mailing Address - Fax:402-463-2450
Practice Address - Street 1:2115 N KANSAS AVE STE 105
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2640
Practice Address - Country:US
Practice Address - Phone:402-463-2454
Practice Address - Fax:402-463-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========23Medicaid
NE=========23Medicaid