MR. LARRY E. TIDYMAN PA-C NPI 1972690345

NPI Information

NPI: 1972690345
Provider Name: MR. LARRY E. TIDYMAN, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
1313 N CHEYENNE ST
BENKELMAN, NE
ZIP 69021
Phone: (308) 423-2151
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MR. Larry E. Tidyman, PA-C is a medical physician assistant in Benkelman, NE. MR. Larry E. Tidyman, PA-C NPI is 1972690345. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1313 N CHEYENNE ST
BENKELMAN, NE
ZIP 69021-074
Phone: (308) 423-2151
Fax: (308) 423-2217

The enumeration date for this NPI number is 10/6/2006 and was last updated on 9/1/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	343	NEBRASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	37814	OTHER	NEBRASKA	BCBS OF NE
2	P45619	MEDICARE UPIN	NEBRASKA
3	2287458901	MEDICAID	KANSAS
4	274877	MEDICARE PIN	NEBRASKA
5	970023465	MEDICARE ID-TYPE UNSPECIFIED	NEBRASKA	RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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