1972948545 NPI number — PRISCILLA M. CORREA, M.D., A PROFESSIONAL CORPORATION

Table of content: (NPI 1972948545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972948545 NPI number — PRISCILLA M. CORREA, M.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRISCILLA M. CORREA, M.D., A PROFESSIONAL CORPORATION
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:
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:
1972948545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4828 S 24TH ST
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:
68107-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-731-9100
Provider Business Mailing Address Fax Number:
402-731-1297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4828 S 24TH ST
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:
68107-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-731-9100
Provider Business Practice Location Address Fax Number:
402-731-1297
Provider Enumeration Date:
05/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CORREA
Authorized Official First Name:
PRISCILLA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-731-9100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  18633 , 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)





Copyright © 2007-2024 www.npivalidator.com