1497956775 NPI number — LOESS HILLS ORTHOPEDICS

Table of content: (NPI 1497956775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497956775 NPI number — LOESS HILLS ORTHOPEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOESS HILLS ORTHOPEDICS
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:
1497956775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51502-0648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-978-5151
Provider Business Mailing Address Fax Number:
402-341-3616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 EDMUNDSON PL STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-4658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-978-5151
Provider Business Practice Location Address Fax Number:
402-341-3616
Provider Enumeration Date:
05/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAUMERT
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO JEMH
Authorized Official Telephone Number:
712-396-6064

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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