1659465441 NPI number — DR. KENNETH WILLIAM VERMAAS III PSY D

Table of content: DR. KENNETH WILLIAM VERMAAS III PSY D (NPI 1659465441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659465441 NPI number — DR. KENNETH WILLIAM VERMAAS III PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERMAAS
Provider First Name:
KENNETH
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PSY D
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:
1659465441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1251 N 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEBRASKA CITY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68410-1120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-873-7262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1903 4TH CORSO
Provider Second Line Business Practice Location Address:
BLUE VALLEY BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
NEBRASKA CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68410-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-873-5505
Provider Business Practice Location Address Fax Number:
402-873-6374
Provider Enumeration Date:
10/03/2006

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: 103TC0700X , with the licence number:  596 , 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: 10025208200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470528515-01 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08237 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025207700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470528515-04 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025208700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470528515-08 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025208500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025208600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470528515-10 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025208000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470528515-02 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96005 . This is a "BCBS AUX NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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