Basic Information
| Provider Information | |||||||||
| NPI: | 1164448510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASES ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8111 DODGE ST | ||||||||
| Address2: | SUITE 363 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681144119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023548155 | ||||||||
| FaxNumber: | 4023548159 | ||||||||
| Practice Location | |||||||||
| Address1: | 8111 DODGE ST | ||||||||
| Address2: | SUITE 363 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681144119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023548155 | ||||||||
| FaxNumber: | 4023548159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 03/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | PFEIFFER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4023548155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 07614 | 01 | NE | BCBS | OTHER | 0717280 | 05 | IA | MEDICAID |