John Michael Black
Individual provider Active NPI General Practice Physician · Offutt Afb, NE
NPI 1497375570 · NPPES record last updated Apr 6, 2022
Key facts
- NPI
- 1497375570
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 34164 (NE)
- Practice address
- 2501 Capehart Rd
Offutt Afb, NE 68113-1043 - Phone
- (402) 232-9431
- Fax
- (402) 294-9138
- NPI assigned
- Apr 20, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34164 | NE | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 34164 | NE | Yes |
Addresses
Primary practice location
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Mailing address
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Phone (402) 232-9431
Other providers in Offutt Afb, NE
- Jacqueline Annette Baude
- Elizabeth Ann Beal
- Francis Eugene Becker
- Derik Grant Bendixsen
- Catherine Fern Bensken
- Lynn Bojanski
- Andreanna Elizabeth Bowers
- Michelle Marie Bray
- Samuel Bretey
- Ashley Dianne Brown
All providers in Offutt Afb, NE · General Practice Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.