1437101102 NPI number — CHRISTINE F URBOM PT

Table of content: CHRISTINE F URBOM PT (NPI 1437101102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437101102 NPI number — CHRISTINE F URBOM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URBOM
Provider First Name:
CHRISTINE
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1437101102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC COOK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69001-0789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-962-5403
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 HOWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68967-6754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-962-5402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

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: 225100000X , with the licence number:  NE-355 , 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: 39661 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6400389 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: F242251 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00060541 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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