1962791764 NPI number — STATE OF NEBRASKA DEPT. OF ADMIN. SERVICES

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 1962791764 NPI number — STATE OF NEBRASKA DEPT. OF ADMIN. SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF NEBRASKA DEPT. OF ADMIN. SERVICES
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:
400 STATE BUILDING
Provider Other Organization Name Type Code:
3
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:
1962791764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 LINCOLN ST
Provider Second Line Business Mailing Address:
3104 STATE AVE
Provider Business Mailing Address City Name:
BEATRICE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68310-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-223-6600
Provider Business Mailing Address Fax Number:
402-223-7589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 LINCOLN ST
Provider Second Line Business Practice Location Address:
3104 STATE AVE
Provider Business Practice Location Address City Name:
BEATRICE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68310-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-223-6600
Provider Business Practice Location Address Fax Number:
402-223-7589
Provider Enumeration Date:
04/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
CORINA
Authorized Official Middle Name:
Authorized Official Title or Position:
FACILITY ADMINISTRATOR
Authorized Official Telephone Number:
402-223-6600

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  ICFMR07 , 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)





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