1710023288 NPI number — ANNIE JEFFREY MEMORIAL COUNTY HEALTH

Table of content: (NPI 1710023288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710023288 NPI number — ANNIE JEFFREY MEMORIAL COUNTY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNIE JEFFREY MEMORIAL COUNTY HEALTH
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:
ANNIE JEFFREY MEM CNTY HSP PHY
Provider Other Organization Name Type Code:
3
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:
1710023288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
531 BEEBE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSCEOLA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68651-5537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-747-2031
Provider Business Mailing Address Fax Number:
402-747-1405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 BEEBE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSCEOLA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68651-5537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-747-2031
Provider Business Practice Location Address Fax Number:
402-747-1405
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAIN
Authorized Official First Name:
REGINALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CONSULTANT PHARMACIST
Authorized Official Telephone Number:
308-940-2592

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  640001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2811354 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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