1982780110 NPI number — REBECCA S RUNDLETT MD

Table of content: REBECCA S RUNDLETT MD (NPI 1982780110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982780110 NPI number — REBECCA S RUNDLETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUNDLETT
Provider First Name:
REBECCA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLATT
Provider Other First Name:
REBECCA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982780110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7440 S 91ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68526-9797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-489-6555
Provider Business Mailing Address Fax Number:
402-328-3770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7440 S 91ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68526-9797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-489-6555
Provider Business Practice Location Address Fax Number:
402-328-3770
Provider Enumeration Date:
10/31/2006

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: 207RC0000X , with the licence number:  17134 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 04-30389 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 17134 , 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: 10026072500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592301 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0537076 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592302 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592305 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592306 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592313 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100295920A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2454893 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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