1255334124 NPI number — DR. GREG A FITZKE MD

Table of content: DR. GREG A FITZKE MD (NPI 1255334124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255334124 NPI number — DR. GREG A FITZKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZKE
Provider First Name:
GREG
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1255334124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 S 70TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-7901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-441-4760
Provider Business Mailing Address Fax Number:
402-441-4764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S 70TH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-441-4760
Provider Business Practice Location Address Fax Number:
402-441-4764
Provider Enumeration Date:
05/24/2005

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: 208600000X , with the licence number:  22161 , 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: 100424120B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207627203 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 236388 . This is a "MIDLANDS - SURGICAL ASSOC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 68510A004 . This is a "WPS/TRIWEST - SURGICAL" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1700535 . This is a "SHARE ADV - PROMED" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1714915 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30654 . This is a "BCBS - PROMED" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1700512 . This is a "UHC - SURGICAL ASSOC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 30348 . This is a "BCBS - SURGICAL ASSOC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: P00228457 . This is a "RRM - PROMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00331882 . This is a "RRM" identifier . This identifiers is of the category "OTHER".