1760545149 NPI number — DR. THOMAS J MOREHEAD JR. D.C.

Table of content: DR. THOMAS J MOREHEAD JR. D.C. (NPI 1760545149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760545149 NPI number — DR. THOMAS J MOREHEAD JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOREHEAD
Provider First Name:
THOMAS
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.C.
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:
1760545149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5002 S 24TH ST STE 200
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:
68107-2754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-339-2283
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2281 S 67TH 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:
68106-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-331-0392
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

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: 111N00000X , with the licence number:  1359 , 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: 20-4485349 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 246104 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 246104 . This is a "AENTA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 246104 . This is a "AMERIBAN IEC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025236300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20-4485349 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 246104 . This is a "CIGNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 09722 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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