1326013749 NPI number — RYDALE MEDICAL, INC.

Table of content: MS. KATHERINE BALESTERI (NPI 1669234266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326013749 NPI number — RYDALE MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYDALE MEDICAL, INC.
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:
1326013749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16909 LAKESIDE HILLS PLZ
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68130-4654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-697-3949
Provider Business Mailing Address Fax Number:
402-697-3950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16909 LAKESIDE HILLS PLZ
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68130-4654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-697-3949
Provider Business Practice Location Address Fax Number:
402-697-3950
Provider Enumeration Date:
02/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOODLETT
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-697-3949

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BD1200X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332U00000X , with the licence number: NONE REQUIRED , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: NONE REQUIRED , 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: 10025338400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: D09862 . This is a "BCBS NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".