# FAMILY MEDICAL CENTER OF HASTINGS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124131032
- **Authorized official:** GERRY THEISEN (ADMINISTRATOR)
- **Authorized official phone:** (402) 462-8456

## Contact information

- **Practice address:** 1021 W 14TH ST, HASTINGS, NE 68901-3046
- **Practice address phone:** (402) 463-2423
- **Practice address fax:** (402) 463-9697
- **Mailing address:** PO BOX 968, HASTINGS, NE 68902-0968
- **Mailing address phone:** (402) 462-8456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 01/24/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02842 | BCBS NE | NE |
| 01 | — | CO4191 | RAILROAD MEDICARE | NE |