Basic Information
| Provider Information | |||||||||
| NPI: | 1457322281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 Q STREET | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024210904 | ||||||||
| FaxNumber: | 4024210946 | ||||||||
| Practice Location | |||||||||
| Address1: | 3910 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685164783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024347383 | ||||||||
| FaxNumber: | 4024347382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 10/30/2014 | ||||||||
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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 | 207Q00000X | 16997 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080179259 | 01 | RAILROAD MEDICARE | OTHER | 32390 | 01 | NE | BC/BS | OTHER | 10026082500 | 05 | NE | MEDICAID | 47069425800 | 05 | NE | MEDICAID | 4210 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER | 4391 | 01 | NE | MIDLANDS CHOICE | OTHER |