1134230758 NPI number — LYLIA M FAHMY M.D.

Table of content: LYLIA M FAHMY M.D. (NPI 1134230758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134230758 NPI number — LYLIA M FAHMY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAHMY
Provider First Name:
LYLIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1134230758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4951 CENTER ST STE 206
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:
68106-3252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-933-7247
Provider Business Mailing Address Fax Number:
402-933-7196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4951 CENTER ST STE 206
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:
68106-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-933-7247
Provider Business Practice Location Address Fax Number:
402-933-7196
Provider Enumeration Date:
08/31/2006

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: 207V00000X , with the licence number:  36383 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 23205 , 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: 03908 . This is a "BCBSN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0701259 . This is a "SHARE ADVANTAGE-S. 24TH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4473371 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025907600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42150546520 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701260 . This is a "SHARE ADVANTAGE-LAKESIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0701261 . This is a "SHARE ADVANTAGE-HARLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45490 . This is a "BCBS OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 94341 . This is a "CENTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 94346 . This is a "WELLMARK-S. 24TH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0473371 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701258 . This is a "SHARE ADVANTAGE-CENTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42150546516 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42150546517 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5473371 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 248479 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0701288 . This is a "SHARE ADVANTAGE-1 EDMUNDS" identifier . This identifiers is of the category "OTHER".




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