1588614481 NPI number — CRETE AREA MEDICAL CENTER

Table of content: (NPI 1588614481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588614481 NPI number — CRETE AREA MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRETE AREA MEDICAL CENTER
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:
6
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:
1588614481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860873
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-826-2102
Provider Business Mailing Address Fax Number:
402-826-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBER
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68465-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-821-3293
Provider Business Practice Location Address Fax Number:
402-821-2450
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LACY
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
402-826-2102

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025116800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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