1992731574 NPI number — MARJORIE S BISENIUS D.O.

Table of content: MARJORIE S BISENIUS D.O. (NPI 1992731574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992731574 NPI number — MARJORIE S BISENIUS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISENIUS
Provider First Name:
MARJORIE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1992731574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 S 144TH ST STE 280
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:
68144-5252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-778-5490
Provider Business Mailing Address Fax Number:
402-614-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 S 144TH ST
Provider Second Line Business Practice Location Address:
#280
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68144-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-778-5490
Provider Business Practice Location Address Fax Number:
402-778-5499
Provider Enumeration Date:
06/24/2006

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: 207Q00000X , with the licence number:  302 , 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: 2543405 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10024982500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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