1316094691 NPI number — MS. NOEL C GRIFFITH AUD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316094691 NPI number — MS. NOEL C GRIFFITH AUD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GRIFFITH

Provider First Name:

NOEL

Provider Middle Name:

C

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

AUD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

BOORTZ

Provider Other First Name:

NOEL

Provider Other Middle Name:

C

Provider Other Name Prefix Text:

MS.

Provider Other Name Suffix Text:

Provider Other Credential Text:

M.A.

Provider Other Last Name Type Code:

1

NPI Number:

1316094691

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/19/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

555 N 30TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

OMAHA

Provider Business Mailing Address State Name:

NE

Provider Business Mailing Address Postal Code:

68131-2136

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

402-280-8100

Provider Business Mailing Address Fax Number:

402-280-8103

Provider First Line Business Practice Location Address:

555 N 30TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OMAHA

Provider Business Practice Location Address State Name:

NE

Provider Business Practice Location Address Postal Code:

68131-2136

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

402-498-6540

Provider Business Practice Location Address Fax Number:

402-498-6357

Provider Enumeration Date:

01/05/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 231H00000X , with the licence number:  243 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 237600000X , with the licence number: 243 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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• Identifier: 1717967 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 2717694 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".