1497982086 NPI number — TODD R. LOVGREN MD

Table of content: AMANDA GOBLE (NPI 1669116042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497982086 NPI number — TODD R. LOVGREN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVGREN
Provider First Name:
TODD
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1497982086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2797
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:
68103-2797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-354-4230
Provider Business Mailing Address Fax Number:
402-354-6171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 N 190TH PLZ
Provider Second Line Business Practice Location Address:
SUITE 2400
Provider Business Practice Location Address City Name:
ELKHORN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68022-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-815-1970
Provider Business Practice Location Address Fax Number:
402-815-1595
Provider Enumeration Date:
06/22/2009

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: 207VM0101X , with the licence number:  47924 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 26651 , 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: 470376604-16 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497982086 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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