1194880740 NPI number — DR. GINA DIRENZO-COFFEY M.D.

Table of content: DR. GINA DIRENZO-COFFEY M.D. (NPI 1194880740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194880740 NPI number — DR. GINA DIRENZO-COFFEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIRENZO-COFFEY
Provider First Name:
GINA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIRENZO
Provider Other First Name:
GINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194880740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N 30TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68131-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-280-8100
Provider Business Mailing Address Fax Number:
402-280-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14080 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYS TOWN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68010-7513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-778-6900
Provider Business Practice Location Address Fax Number:
402-778-6917
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  21462 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0206X , with the licence number: 21462 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1200589 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35173 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0538587 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538587 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200598 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200599 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1201446 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1201455 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03484 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1200597 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2538587 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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