Basic Information
| Provider Information | |||||||||
| NPI: | 1093759797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELBER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100 | ||||||||
| Address2: | |||||||||
| City: | PENDER | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680470100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023854004 | ||||||||
| FaxNumber: | 4023854041 | ||||||||
| Practice Location | |||||||||
| Address1: | 958 WELLNESS WAY STE 1 | ||||||||
| Address2: | |||||||||
| City: | PENDER | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680474518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023853033 | ||||||||
| FaxNumber: | 4023853092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1122 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 42128384921 | 05 | NE | MEDICAID | 03381 | 01 | NE | BCBSNE | OTHER | 1206839 | 05 | NE | MEDICAID | 92354 | 01 | NE | WELLMARK BCBS IA | OTHER |