1275711319 NPI number — MARK R. COBLEIGH

Table of content: (NPI 1275711319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275711319 NPI number — MARK R. COBLEIGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK R. COBLEIGH
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:
BELLEVUE CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
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:
1275711319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10403 S 15TH ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68123-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-734-6711
Provider Business Mailing Address Fax Number:
402-734-4162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10403 S 15TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68123-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-734-6711
Provider Business Practice Location Address Fax Number:
402-734-4162
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COBLEIGH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-734-6711

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  633 , 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: 826350714 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 4561145 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 09618 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0991463 . This is a "MEDICAID OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 4480052 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 097692 . This is a "MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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