Basic Information
| Provider Information | |||||||||
| NPI: | 1184797110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTZELL | ||||||||
| FirstName: | TRISTAN | ||||||||
| MiddleName: | LAYTON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 N 27TH ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028448291 | ||||||||
| FaxNumber: | 4028448292 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 N 27TH ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028448291 | ||||||||
| FaxNumber: | 4028448292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 08/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 26210 | NE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 2082S0105X | 26210 | NE | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 099588036 | 01 | NE | MEDICARE | OTHER | 20079 | 01 | NE | BCBS | OTHER | 10025561800 | 05 | NE | MEDICAID |