1821144874 NPI number — MS. PATRICIA JOAN GILL M.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821144874 NPI number — MS. PATRICIA JOAN GILL M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILL
Provider First Name:
PATRICIA
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANIS
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821144874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2010
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:
01/25/2007

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: 235Z00000X , with the licence number:  510 , 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: 100252727-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100251783-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100251772-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39813 . This is a "BCBS BT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100251782-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39809 . This is a "BCBS ENT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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