1669435343 NPI number — PETER M MORIN M.D.

Table of content: PETER M MORIN M.D. (NPI 1669435343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669435343 NPI number — PETER M MORIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORIN
Provider First Name:
PETER
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1669435343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 N COTNER BLVD SUITE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68505-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-467-4661
Provider Business Mailing Address Fax Number:
405-467-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 N COTNER BLVD
Provider Second Line Business Practice Location Address:
SYE 205
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68505-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-467-4661
Provider Business Practice Location Address Fax Number:
402-467-5006
Provider Enumeration Date:
04/11/2006

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: 207Q00000X , with the licence number:  18258 , 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: 47054632400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080028227 . This is a "RAILROAD MC ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 18258 . This is a "NE STATE LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 00258 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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