1265584197 NPI number — MOSAIC

Table of content: MRS. ROBYN MICHELE ERHARDT NP (NPI 1366413395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265584197 NPI number — MOSAIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSAIC
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:
1265584197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4980 S 118TH 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:
68137-2220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-896-3884
Provider Business Mailing Address Fax Number:
402-894-4780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 E 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51546-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-644-2378
Provider Business Practice Location Address Fax Number:
712-664-3501
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOLE
Authorized Official First Name:
JERI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
402-896-5827

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1439232 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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