1114958337 NPI number — CREIGHTON SAINT JOSEPH REGIONAL HEALTH CARE SYSTEM, L.L.C.

Table of content: (NPI 1114958337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114958337 NPI number — CREIGHTON SAINT JOSEPH REGIONAL HEALTH CARE SYSTEM, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREIGHTON SAINT JOSEPH REGIONAL HEALTH CARE SYSTEM, L.L.C.
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:
CREIGHTON UNIVERSITY MEDICAL CENTER
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:
1114958337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849791
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-9791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-449-4342
Provider Business Mailing Address Fax Number:
402-449-5020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 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:
68131-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-449-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  260010 , 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: 01400357 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100039180A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180493700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8033723 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP32674 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000426 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00194 . This is a "BCBS OF NEBRASKA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1740853 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100106590A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 372061 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95002366 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002180400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76278 . This is a "COVENTRY HEALTH CARE KANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HOS00030N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0992917 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130746105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 636781020 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00524939X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP42674 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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