1437330495 NPI number — MR. ALVIN ORTEGA BENEMERITO RPT

Table of content: MR. ALVIN ORTEGA BENEMERITO RPT (NPI 1437330495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437330495 NPI number — MR. ALVIN ORTEGA BENEMERITO RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENEMERITO
Provider First Name:
ALVIN
Provider Middle Name:
ORTEGA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1437330495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38
Provider Second Line Business Mailing Address:
621 NORTH MAIN ST
Provider Business Mailing Address City Name:
LONG PINE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69217-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-273-3164
Provider Business Mailing Address Fax Number:
413-431-5660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E SOUTH ST
Provider Second Line Business Practice Location Address:
RCH REHAB DEPARTMENT
Provider Business Practice Location Address City Name:
BASSETT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68714-5508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-684-3366
Provider Business Practice Location Address Fax Number:
413-431-5660
Provider Enumeration Date:
11/19/2007

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: 225100000X , with the licence number:  1353 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 0932 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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