1508321027 NPI number — SPAMM LLC

Table of content: (NPI 1508321027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508321027 NPI number — SPAMM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPAMM LLC
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:
1508321027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 437
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BEND
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68649-0437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-652-3217
Provider Business Mailing Address Fax Number:
402-652-8219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 W 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLER
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68661-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-352-3020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
JED
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT - SECRETARY
Authorized Official Telephone Number:
402-652-3217

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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