1992876726 NPI number — DR. PAULA ANN BENNETT M.D.

Table of content: DR. PAULA ANN BENNETT M.D. (NPI 1992876726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992876726 NPI number — DR. PAULA ANN BENNETT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
PAULA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1992876726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX HH
Provider Second Line Business Mailing Address:
HWY 75/77
Provider Business Mailing Address City Name:
WINNEBAGO
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-878-2231
Provider Business Mailing Address Fax Number:
402-878-2535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 75/77
Provider Second Line Business Practice Location Address:
WINNEBAGO PHS HOSPITAL,
Provider Business Practice Location Address City Name:
WINNEBAGO
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68071-0767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-878-2231
Provider Business Practice Location Address Fax Number:
402-878-2535
Provider Enumeration Date:
11/13/2006

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:  2007011369 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10068419 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2875073 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5286A . This is a "EMPIRE BC BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 603347 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2644327 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 326043511 . This is a "MISSOURI MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 58211 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5797739 . This is a "AETNA NON HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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