1477664951 NPI number — ADA I ORTIZ-BIANCHI M.D.

Table of content: ADA I ORTIZ-BIANCHI M.D. (NPI 1477664951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477664951 NPI number — ADA I ORTIZ-BIANCHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ-BIANCHI
Provider First Name:
ADA
Provider Middle Name:
I
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:
1477664951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 RIDGE ST
Provider Second Line Business Mailing Address:
#307
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51503-4643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-329-5700
Provider Business Mailing Address Fax Number:
712-329-5759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 RIDGE ST
Provider Second Line Business Practice Location Address:
#307
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-329-5700
Provider Business Practice Location Address Fax Number:
712-329-5759
Provider Enumeration Date:
08/31/2006

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: 207V00000X , with the licence number:  23300 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 36181 , 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: 06286 . This is a "WELLMARK-ATLANTIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2591883 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0591883 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4591883 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025407200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701233 . This is a "SHARE ADV. - RIDGE ST." identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0701236 . This is a "SHARE ADV - 24TH ST." identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0701382 . This is a "SHARE ADV - MERCY" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 07268 . This is a "BCBSN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42150546516 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42150546518 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1591883 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42150546520 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701235 . This is a "SHARE ADV - LAKESIDE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 42150546517 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701234 . This is a "SHARE ADV - CENTER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 39342 . This is a "WELLMARK-201 RIDGE" identifier . This identifiers is of the category "OTHER".




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