1174531495 NPI number — SUZANNE M. VANDENHUL MD

Table of content: (NPI 1457982365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174531495 NPI number — SUZANNE M. VANDENHUL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDENHUL
Provider First Name:
SUZANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMYKACZ
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174531495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 S 16TH ST
Provider Second Line Business Mailing Address:
SUITE 400A
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68502-3796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-483-8590
Provider Business Mailing Address Fax Number:
402-483-8599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4333 S 86TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68526-9260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-483-8500
Provider Business Practice Location Address Fax Number:
402-483-8501
Provider Enumeration Date:
08/03/2006

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: 207Q00000X , with the licence number:  22281 , 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: 237614 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47078085732 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470780857 32 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-03824 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01-05357 . This is a "UHC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 00455 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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