1043301138 NPI number — THE COUNTY OF THAYER

Table of content: (NPI 1043301138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043301138 NPI number — THE COUNTY OF THAYER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COUNTY OF THAYER
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:
1043301138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBRON
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68370-0201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-768-6060
Provider Business Mailing Address Fax Number:
402-768-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 N. 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBRON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68370-0201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-768-6060
Provider Business Practice Location Address Fax Number:
402-768-6071
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERGOTT
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
402-768-6060

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1295 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , 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: 590921898 . This is a "RAILRAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: F242250 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 009494 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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