1851358600 NPI number — OLEG P GEORGIEV MD

Table of content: OLEG P GEORGIEV MD (NPI 1851358600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851358600 NPI number — OLEG P GEORGIEV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGIEV
Provider First Name:
OLEG
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1851358600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3471
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68103-0471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-335-1952
Provider Business Mailing Address Fax Number:
605-373-9971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6709 S. MINNESOTA AVENUE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-2593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-496-7002
Provider Business Practice Location Address Fax Number:
877-543-8251
Provider Enumeration Date:
04/26/2006

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: 207RN0300X , with the licence number:  4680 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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