Basic Information
| Provider Information | |||||||||
| NPI: | 1568400059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JERABEK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | D..O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 W NORFOLK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023714880 | ||||||||
| FaxNumber: | 4026447647 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 W NORFOLK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023714880 | ||||||||
| FaxNumber: | 4026447647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 06/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 465 | NE | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 098713 | 01 | NE | MEDICARE-IMC/BERGAN | OTHER | 10025709900 | 05 | NE | MEDICAID | I21224 | 01 | IA | MEDICARE-MERCY | OTHER | 10025745600 | 05 | NE | MEDICAID | 47055043813 | 05 | NE | MEDICAID | NA1324 | 01 | NE | MEDICARE-MIDLANDS | OTHER | 10025507800 | 05 | IA | MEDICAID |