1821194358 NPI number — OURS, INC.

Table of content: (NPI 1821194358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821194358 NPI number — OURS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OURS, INC.
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:
HOLDREGE PHARMACY
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:
1821194358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLDREGE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68949-0804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-995-5414
Provider Business Mailing Address Fax Number:
308-995-2051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 W 14TH AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
HOLDREGE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68949-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-995-5414
Provider Business Practice Location Address Fax Number:
308-995-2051
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
308-995-5414

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2796 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 2796 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2802773 . This is a "NCPDP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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