1265590822 NPI number — ARTHUR S ANNIN MD PC

Table of content: (NPI 1265590822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265590822 NPI number — ARTHUR S ANNIN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR S ANNIN MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265590822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6630 REXFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
531-530-9136
Provider Business Mailing Address Fax Number:
402-382-1918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6630 REXFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-530-9136
Provider Business Practice Location Address Fax Number:
402-382-1918
Provider Enumeration Date:
12/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANNIN
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
531-530-9136

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  12641 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DG2631 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 07397 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 07397 . This is a "BLUE CROSS BLUE SHIELD NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".