1295897239 NPI number — BEHAVIORAL HEALTH SPECIALISTS INC COLUMBUS CLINIC

Table of content: (NPI 1295897239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295897239 NPI number — BEHAVIORAL HEALTH SPECIALISTS INC COLUMBUS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL HEALTH SPECIALISTS INC COLUMBUS CLINIC
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:
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:
1295897239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 W NORFOLK AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-370-3140
Provider Business Mailing Address Fax Number:
402-370-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4432 SUNRISE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-564-9994
Provider Business Practice Location Address Fax Number:
402-562-6458
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRODERS
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
402-370-3140

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025341800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025477400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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