1134522808 NPI number — WRIGHT TURN LANE PC

Table of content: (NPI 1134522808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134522808 NPI number — WRIGHT TURN LANE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT TURN LANE 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:
6
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:
1134522808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8419 S 73RD PLZ STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAPILLION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68046-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-991-9060
Provider Business Mailing Address Fax Number:
402-991-9052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1219 APPLEWOOD DR STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAPILLION
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68046-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-502-0602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CRANE
Authorized Official First Name:
PETE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-991-9060

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: NA1991 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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