1376871913 NPI number — COLLEEN A. CONOLEY, P.C.

Table of content: (NPI 1376871913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376871913 NPI number — COLLEEN A. CONOLEY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLEEN A. CONOLEY, P.C.
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:
1376871913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11330 Q ST STE 232
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:
68137-3679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-597-2290
Provider Business Mailing Address Fax Number:
402-597-2345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11330 Q ST STE 232
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68137-3679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-597-2290
Provider Business Practice Location Address Fax Number:
402-597-2345
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CONOLEY
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-597-2290

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  642 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 642 , 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: 08228 . This is a "BLUE CROSS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025173700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246811 . This is a "MIDLAND'S CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025420600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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