Basic Information
| Provider Information | |||||||||
| NPI: | 1265494504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIRO | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CPO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22832 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685422832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838898 | ||||||||
| FaxNumber: | 4024355504 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 S 16TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838898 | ||||||||
| FaxNumber: | 4024355504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1744P3200X | CPO01445 | NE | Y | Other Service Providers | Specialist | Prosthetics Case Management |
ID Information
| ID | Type | State | Issuer | Description | 08911 | 01 | NE | BCBS | OTHER | 1160090001 | 01 | SD | DMERC REGION D | OTHER | 6886853101 | 05 | KS | MEDICAID | 191518500 | 05 | MN | MEDICAID | 9156530 | 05 | SD | MEDICAID | 1160090002 | 01 | NE | DMERC REGION D | OTHER |