Family and Sport Medicine, PC
Organization Active NPI Sports Medicine (Family Medicine) Physician · Gothenburg, NE
NPI 1932201803 · NPPES record last updated Apr 30, 2012
Key facts
- NPI
- 1932201803
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- License
- 16542 (NE)
- Legal business name
- FAMILY AND SPORT MEDICINE, PC
- Practice address
- 918 20TH Street
Gothenburg, NE 69138-1237 - Phone
- (308) 537-7131
- Fax
- (308) 537-7310
- NPI assigned
- Sep 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Gerald E Matzke Jr., M.D.
- Title
- Owner
- Phone
- (308) 537-7131
Practitioners 2
-
David D Hult, M.D.
-
Carol L Shackleton, M.D.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician |
207QS0010X | 16542 | NE | Yes |
Addresses
Primary practice location
918 20TH Street
Gothenburg, NE 69138-1237
Mailing address
918 20TH Street
Gothenburg, NE 69138-1237
Phone (308) 537-7131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10026082600 | Medicaid | NE |
Other providers in Gothenburg, NE
- Carson Lee Davis
- Kandace Davis
- Colby Thomas Delatour
- Lacy J Dye
- Jackie E Erb
- Robyn Favinger
- Erin Feather
- Cynthia Ann Foresman
- Kyle Ryan Fornoff
- Frontier Home Medical, Inc
All providers in Gothenburg, NE · Sports Medicine (Family Medicine) 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 30, 2012. 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.