1952363533 NPI number — MR. KENT R DINUCCI DPM

Table of content: MR. KENT R DINUCCI DPM (NPI 1952363533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952363533 NPI number — MR. KENT R DINUCCI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINUCCI
Provider First Name:
KENT
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1952363533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8625 Q STREET
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:
68127-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-331-0221
Provider Business Mailing Address Fax Number:
402-331-9903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8625 Q STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68127-3673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-331-0221
Provider Business Practice Location Address Fax Number:
402-331-9903
Provider Enumeration Date:
04/06/2006

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: 213ES0103X , with the licence number:  300 , 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: P00282104 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 249313 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10025339700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02569 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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