Provider Demographics
NPI:1366406928
Name:WILLIAMSBURG FAMILY PHYSICIANS P.C.
Entity type:Organization
Organization Name:WILLIAMSBURG FAMILY PHYSICIANS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:JIROVEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-423-1382
Mailing Address - Street 1:6041 VILLAGE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6619
Mailing Address - Country:US
Mailing Address - Phone:402-423-1382
Mailing Address - Fax:402-423-3590
Practice Address - Street 1:6041 VILLAGE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6619
Practice Address - Country:US
Practice Address - Phone:402-423-1382
Practice Address - Fax:402-423-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE356261QP2300X
NE17216261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH92871Medicare UPIN
NEE28763Medicare UPIN