1811986045 NPI number — CITY OF CENTRAL CITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811986045 NPI number — CITY OF CENTRAL CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CENTRAL CITY
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:
1811986045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10802 FARNAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
531-895-5853
Provider Business Mailing Address Fax Number:
877-343-0131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68826-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-218-4392
Provider Business Practice Location Address Fax Number:
877-343-0131
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KOLAR
Authorized Official First Name:
BEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
308-850-0398

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  5112 , 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: 09377 . This is a "BLUE CROSS PROVIDER NO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590121096 . This is a "RAILROAD MEDICARE PROV NO" identifier . This identifiers is of the category "OTHER".




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