1427056100 NPI number — COLONOSCOPY CENTER INC

Table of content: (NPI 1427056100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427056100 NPI number — COLONOSCOPY CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLONOSCOPY CENTER INC
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:
1427056100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9850 NICHOLAS STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-343-1122
Provider Business Mailing Address Fax Number:
402-343-1177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9850 NICHOLAS STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-343-1122
Provider Business Practice Location Address Fax Number:
402-343-1177
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STOCKTON
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
402-343-1122

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASC038 , 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: 0570762 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98448 . This is a "BCBS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: P00106867 . This is a "RR MEDICARE PALMETO GPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: D01791 . This is a "BCBS OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025038900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com