1467866277 NPI number — ADAM RASMUSSEN MD

Table of content: ADAM RASMUSSEN MD (NPI 1467866277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467866277 NPI number — ADAM RASMUSSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASMUSSEN
Provider First Name:
ADAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1467866277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 OLSON DR
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
PAPILLION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68046-2974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-991-2200
Provider Business Mailing Address Fax Number:
402-991-2242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 OLSON DR STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAPILLION
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68046-2974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-991-2200
Provider Business Practice Location Address Fax Number:
402-991-2242
Provider Enumeration Date:
06/19/2014

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: 207Q00000X , with the licence number:  28749 , 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: 10026399800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com