1881690261 NPI number — SUTTON SKIN AND EYE CLINIC PC

Table of content: (NPI 1881690261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881690261 NPI number — SUTTON SKIN AND EYE CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTON SKIN AND EYE CLINIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUTTON DERMATOLOGY AND AESTHETICS
Provider Other Organization Name Type Code:
3
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:
1881690261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6068
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:
68506-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-484-9009
Provider Business Mailing Address Fax Number:
402-483-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 STEPHANIE LN STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-5332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-484-9009
Provider Business Practice Location Address Fax Number:
402-483-4223
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-484-9009

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CU0481 . This is a "RAILROAD MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




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