1568456903 NPI number — HEALTHSERVICESONE, P.C.

Table of content: (NPI 1568456903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568456903 NPI number — HEALTHSERVICESONE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHSERVICESONE, P.C.
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:
1568456903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2168
Provider Second Line Business Mailing Address:
3500 CENTRAL AVE SUITE C
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68848-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-865-2500
Provider Business Mailing Address Fax Number:
308-865-2506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-865-2500
Provider Business Practice Location Address Fax Number:
308-865-2506
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILKINSON
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
308-865-2500

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  76009 , 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: 100212760C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490004279 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 076009 . This is a "STATE LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 32370 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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