1093904807 NPI number — RODNEY L NITCHER DO PC

Table of content: DR. JARED BONECUTTER PT, DPT (NPI 1295182376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093904807 NPI number — RODNEY L NITCHER DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODNEY L NITCHER DO 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:
1093904807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9239 WEST CENTER RD
Provider Second Line Business Mailing Address:
SUITE 226
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-354-8040
Provider Business Mailing Address Fax Number:
402-354-8044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9239 WEST CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-354-8040
Provider Business Practice Location Address Fax Number:
402-354-8044
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NITCHER
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-354-8040

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  93 , 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: 1002530300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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