1326107723 NPI number — DR. BEVERLY JEAN PATITZ PHD, LIMHP, LADC CPC

Table of content: DR. BEVERLY JEAN PATITZ PHD, LIMHP, LADC CPC (NPI 1326107723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326107723 NPI number — DR. BEVERLY JEAN PATITZ PHD, LIMHP, LADC CPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATITZ
Provider First Name:
BEVERLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LIMHP, LADC CPC
Provider Gender Code:
F

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:
1326107723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 EAST 14TH,
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-519-0159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 EAST 14TH,
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-519-0159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

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: 101YA0400X , with the licence number:  688 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 945 , 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: 588458000 . This is a "MAGELLAN MIS NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025039900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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