1689738270 NPI number — ERIC C MCPEAK OD PA

Table of content: (NPI 1689738270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689738270 NPI number — ERIC C MCPEAK OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC C MCPEAK OD PA
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:
1689738270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66434-2232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-742-3021
Provider Business Mailing Address Fax Number:
785-742-3061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1823 CHASE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68355-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-245-2017
Provider Business Practice Location Address Fax Number:
402-245-2018
Provider Enumeration Date:
12/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCPEAK
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
785-742-3021

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D06911 . This is a "GROUP NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: DG7240 . This is a "RR MC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10024975900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100357060C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG0638 . This is a "RR MC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: D06911 . This is a "NE BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".