1043318603 NPI number — DAVID D GREER B.C.O.

Table of content: DAVID D GREER B.C.O. (NPI 1043318603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043318603 NPI number — DAVID D GREER B.C.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREER
Provider First Name:
DAVID
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.C.O.
Provider Gender Code:
M

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:
1043318603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6675 SORENSEN PKWY
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:
68152-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-392-1646
Provider Business Mailing Address Fax Number:
402-573-0568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6675 SORENSEN PKWY
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:
68152-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-392-1646
Provider Business Practice Location Address Fax Number:
402-573-0568
Provider Enumeration Date:
09/20/2006

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: 156FX1700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 47069681000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87608 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0901173 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09971 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: F235055 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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