1871543728 NPI number — DR. BEVERLY LYNN TIMERDING MD

Table of content: DR. BEVERLY LYNN TIMERDING MD (NPI 1871543728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871543728 NPI number — DR. BEVERLY LYNN TIMERDING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMERDING
Provider First Name:
BEVERLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1871543728
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:
900 SO 74 PLZ
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-391-3387
Provider Business Mailing Address Fax Number:
402-391-7821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 MERCY RD
Provider Second Line Business Practice Location Address:
ALEGENT HEALTH BERGAN MERCY EMERGENCY DEPT
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-398-6161
Provider Business Practice Location Address Fax Number:
402-398-6982
Provider Enumeration Date:
05/11/2006

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: 207P00000X , with the licence number:  21873 , 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: 0545756 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47064207113 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com