1063452845 NPI number — DR. ADELEKE E BADEJO M.D., FACS

Table of content: DR. ADELEKE E BADEJO M.D., FACS (NPI 1063452845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063452845 NPI number — DR. ADELEKE E BADEJO M.D., FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADEJO
Provider First Name:
ADELEKE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., FACS
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:
1063452845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3219 CENTRAL AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68847-2958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-865-2370
Provider Business Mailing Address Fax Number:
308-865-2843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3219 CENTRAL AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-2958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-865-2370
Provider Business Practice Location Address Fax Number:
308-865-2843
Provider Enumeration Date:
06/08/2006

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: 207T00000X , with the licence number:  19006 , 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: 140007700 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100143550B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102023 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100143550C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35675 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47084506100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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