Mark William Serbousek, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

17178 Issued in NE

Practice address

1401 East H Street
McCook, NE 69001-1207

Phone

(308) 344-4110

Fax

(304) 344-8369

NPI assigned

Oct 3, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1841287166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 EAST H STREET",
            "address_2": "PO BOX 1207",
            "city": "MCCOOK",
            "state": "NE",
            "postal_code": "690011207",
            "telephone_number": "308-345-4110",
            "fax_number": "308-345-8369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 EAST H STREET",
            "city": "MCCOOK",
            "state": "NE",
            "postal_code": "690011207",
            "telephone_number": "308-344-4110",
            "fax_number": "304-344-8369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERBOUSEK",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "17178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47074801112",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080051714",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4297",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Region II Human Services
• Carrie M Roberts, LCSW LMHP
• Anthony E. Rodewald, PHARMD
• Lori Ryland, PHARMD
• Darin Dale Seligman, DDS
• Paul A Sheets, PT
• Teresa Renee Slaby
• David Harold Smith
• State of Nebraska Dept of Admin Services
• Mary Ann Suda, MA, LMHP, CPC

• Family Medicine Physician in McCook, NE
• Providers in McCook, NE by specialty
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.