1629158365 NPI number — UNMC COLLEGE OF DENTISTRY

Table of content: MRS. PAULA MARIE GELLA OTR OTRL (NPI 1598950362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629158365 NPI number — UNMC COLLEGE OF DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNMC COLLEGE OF DENTISTRY
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:
1629158365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40TH AND HOLDREGE
Provider Second Line Business Mailing Address:
ROOM 2106B
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68583-0740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-472-3492
Provider Business Mailing Address Fax Number:
402-472-5290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 DODGE ST
Provider Second Line Business Practice Location Address:
2ND FLOOR SPC CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-559-6100
Provider Business Practice Location Address Fax Number:
402-552-7765
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAACK
Authorized Official First Name:
RANDAL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ASSISTANT DEAN OF OPERATIONS
Authorized Official Telephone Number:
402-472-3492

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025084700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2956599 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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