1508973082 NPI number — ADVANCED RADIATION THERAPY AND ONCOLOGY, PC

Table of content: KELSEY BARTON FRIEDMAN APRN (NPI 1144860891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508973082 NPI number — ADVANCED RADIATION THERAPY AND ONCOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RADIATION THERAPY AND ONCOLOGY, PC
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:
1508973082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6971
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:
68506-0971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-486-7027
Provider Business Mailing Address Fax Number:
402-486-7300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 S 70TH ST
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:
68510-2462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-483-5799
Provider Business Practice Location Address Fax Number:
402-434-6047
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWELL-BURKE
Authorized Official First Name:
UNDINE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-483-5799

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025009000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB6526 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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