1366513517 NPI number — HEMATOLOGY & ONCOLOGY CONSULTANTS, PC

Table of content: DR. PATRICIO MANUEL ANDRES M.D. (NPI 1306933007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366513517 NPI number — HEMATOLOGY & ONCOLOGY CONSULTANTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY & ONCOLOGY CONSULTANTS, PC
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:
1366513517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 641850
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:
68164-7850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-572-3529
Provider Business Mailing Address Fax Number:
402-572-2892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6901 N 72ND ST
Provider Second Line Business Practice Location Address:
SUITE 2244
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68122-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-572-3529
Provider Business Practice Location Address Fax Number:
402-572-2892
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
CAROLYNNE
Authorized Official Middle Name:
RENEA
Authorized Official Title or Position:
CLINIC COORDINATOR
Authorized Official Telephone Number:
402-572-3529

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  15291 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 13385 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 20876 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 21140 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 22157 , 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: CI2142 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 4417100002 . This is a "DMERC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 4417100002 . This is a "DMERC NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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