1316098684 NPI number — MS. LISA J STILLE M.A.

Table of content: MS. LISA J STILLE M.A. (NPI 1316098684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316098684 NPI number — MS. LISA J STILLE M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILLE
Provider First Name:
LISA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZUBROD
Provider Other First Name:
LISA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316098684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N 30TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68131-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-280-8100
Provider Business Mailing Address Fax Number:
402-280-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 N 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68131-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-452-5000
Provider Business Practice Location Address Fax Number:
402-452-5028
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  236 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: 236 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 06609 . This is a "BCBS BT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100251703-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3588186 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0588186 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2588186 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100251704-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06617 . This is a "BCBS ENT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1588186 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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