1184732943 NPI number — DR. WESLEY ELLWYN SIME PH.D.

Table of content: (NPI 1235539941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184732943 NPI number — DR. WESLEY ELLWYN SIME PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIME
Provider First Name:
WESLEY
Provider Middle Name:
ELLWYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1184732943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 SOUTH 40TH STREET
Provider Second Line Business Mailing Address:
SUITE #335
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-5286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-420-2500
Provider Business Mailing Address Fax Number:
402-420-2501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S 68TH STREET PL
Provider Second Line Business Practice Location Address:
SUITE #500
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-2475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-434-2730
Provider Business Practice Location Address Fax Number:
402-434-3970
Provider Enumeration Date:
08/29/2006

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: 103T00000X , with the licence number:  367 , 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: 345680000 . This is a "MAGELLAN MIS GT SITE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 08057 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 132852 . This is a "VALUE OPTIONS #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 470774254-26 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08140 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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