1477591667 NPI number — MARY A CURTIS M.D.

Table of content: MARY A CURTIS M.D. (NPI 1477591667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477591667 NPI number — MARY A CURTIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURTIS
Provider First Name:
MARY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1477591667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7601 PIONEERS BLVD
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:
68506-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-484-6677
Provider Business Mailing Address Fax Number:
402-484-4476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 PIONEERS BLVD
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:
68506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-484-6677
Provider Business Practice Location Address Fax Number:
402-484-4467
Provider Enumeration Date:
06/02/2006

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: 2085R0202X , with the licence number:  21267 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0904X , with the licence number: 21267 , 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: 01489 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 300104330 . This is a "RR MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47078180813 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05950 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 281799 . This is a "AMI MEDICARE PIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100352160A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0535534 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7788240 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA1330002 . This is a "SMI MEDICARE PIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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