1053582247 NPI number — MID-PLAINS EYECARE CENTER PC

Table of content: (NPI 1053582247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053582247 NPI number — MID-PLAINS EYECARE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-PLAINS EYECARE CENTER PC
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:
1053582247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68446-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-269-2321
Provider Business Mailing Address Fax Number:
402-269-3475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68446-9740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-269-2321
Provider Business Practice Location Address Fax Number:
402-873-5149
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SALANSKY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-269-2321

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  833 , 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: 13691 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 6737 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 2200004 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 410022770 . This is a "RR MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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