Individual
JOHN BECKENHAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
EMILE @ 42ND ST, OMAHA, NE 68198-0001
(402) 559-5000
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
961
NE
363AS0400X
Surgical Physician Assistant
961
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37830
BCBS
NE
05
—
47081304012
—
NE
01
—
68154A018
TRICARE
NE
01
—
970030785
RAILROAD MEDICARE
NE
Enumeration date
06/09/2005
Last updated
02/09/2021
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