1083725337 NPI number — PLANNED PARENTHOOD OF OMAHA CO BLUFFS

Table of content: (NPI 1083725337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083725337 NPI number — PLANNED PARENTHOOD OF OMAHA CO BLUFFS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANNED PARENTHOOD OF OMAHA CO BLUFFS
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:
1083725337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2246 O 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:
68510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-554-1103
Provider Business Mailing Address Fax Number:
402-554-0214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3341 NO 107TH 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:
68134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-496-0088
Provider Business Practice Location Address Fax Number:
402-496-0489
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAFFERTY
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING OFFICE MANAGER
Authorized Official Telephone Number:
402-554-1103

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  110063 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: A051642 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10025088600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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