Basic Information
| Provider Information | |||||||||
| NPI: | 1972653715 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HERD | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11111 S 84TH ST | ||||||||
| Address2: | DEPARTMENT OF EMERGENCY MEDICINE | ||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680464122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025933000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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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 | 207P00000X | 24220 | NE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 37289 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34051 | 01 | IA | BCBS OF NEBRASKA FOR MERCY IOWA | OTHER | 100249951-00 | 05 | NE | MEDICAID | 100251147-00 | 05 | NE | MEDICAID | 70157 | 01 | IA | WELLMARK BCBS | OTHER | 00941 | 01 | NE | BCBS OF NEBRASKA | OTHER | P00444102 | 01 | NE | RRMEDICARE NUMBER FOR MIDLANDS | OTHER |