1336382530 NPI number — ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM

Table of content: (NPI 1336382530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336382530 NPI number — ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
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:
1336382530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N 96TH ST STE 201
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:
68114-2592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-898-8000
Provider Business Mailing Address Fax Number:
402-898-8080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 ROSARY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORNING
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50841-1685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-322-6283
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KUIPER
Authorized Official First Name:
EVERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-343-4420

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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