1750878013 NPI number — DR. ANDREW JACOB CREED MD

Table of content: DR. ANDREW JACOB CREED MD (NPI 1750878013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750878013 NPI number — DR. ANDREW JACOB CREED MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CREED
Provider First Name:
ANDREW
Provider Middle Name:
JACOB
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1750878013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5104 S 79TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALSTON
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68127-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-904-4634
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
988435 NEBRASKA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68198-8440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-836-9138
Provider Business Practice Location Address Fax Number:
402-559-9355
Provider Enumeration Date:
04/21/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 57.247374 . This is a "STATE MEDICAL BOARD OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34492 . This is a "NEBRASKA FULL LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 94-09541 . This is a "KANSAS BOARD OF HEALING ARTS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".