1780748251 NPI number — MS. RENEE PHYLLIS STEIDER

Table of content: MS. RENEE PHYLLIS STEIDER (NPI 1780748251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780748251 NPI number — MS. RENEE PHYLLIS STEIDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIDER
Provider First Name:
RENEE
Provider Middle Name:
PHYLLIS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIDSON
Provider Other First Name:
RENEE
Provider Other Middle Name:
PHYLLIS
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780748251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 265
Provider Second Line Business Mailing Address:
314 M ST
Provider Business Mailing Address City Name:
MC COOL JUNCTION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-366-8406
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 F ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-759-4761
Provider Business Practice Location Address Fax Number:
402-759-4761
Provider Enumeration Date:
12/20/2006

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: 171M00000X , 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: 47052851589 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47052851594 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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