1366774416 NPI number — EMERGENCY PHYSICIANS OF EASTERN NEBRASKA, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366774416 NPI number — EMERGENCY PHYSICIANS OF EASTERN NEBRASKA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIANS OF EASTERN NEBRASKA, 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:
1366774416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4239 FARNAM ST
Provider Second Line Business Mailing Address:
SUITE 326
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68131-2868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-552-3377
Provider Business Mailing Address Fax Number:
402-552-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 BELLEVUE CENTER DRIVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-763-3644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEATLE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-616-1083

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  21078 , 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: 21078 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".