1225322910 NPI number — NEBRASKA SPECIALTY NETWORK, LLC

Table of content: (NPI 1225322910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225322910 NPI number — NEBRASKA SPECIALTY NETWORK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEBRASKA SPECIALTY NETWORK, LLC
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:
1225322910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 Q ST STE 501
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:
68503-3610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-328-4572
Provider Business Mailing Address Fax Number:
402-421-0946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 Q ST STE 501
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:
68503-3610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-328-4572
Provider Business Practice Location Address Fax Number:
402-421-0946
Provider Enumeration Date:
05/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LYNE-ULRICH
Authorized Official First Name:
MARCI
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
402-328-4572

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10026072200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026380000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026283500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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