1154584639 NPI number — CITY OF BELLEVUE

Table of content: (NPI 1154584639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154584639 NPI number — CITY OF BELLEVUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BELLEVUE
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:
1154584639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 WALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68005-5299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-591-4530
Provider Business Mailing Address Fax Number:
402-293-3079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 W 22ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68005-5072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-591-4530
Provider Business Practice Location Address Fax Number:
402-293-3079
Provider Enumeration Date:
07/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
DEE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
402-591-4530

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  5008 , 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: 0401618 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025650800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 614464000 . This is a "US DOL FECA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39466 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 39466 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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