Basic Information
Provider Information | |||||||||
NPI: | 1750661708 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHILDREN'S HOSPITAL & MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8200 DODGE ST | ||||||||
Address2: | CHILDREN'S HOSPITAL & MEDICAL CENTER | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681144113 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4029555400 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9801 GILES RD | ||||||||
Address2: | CHILDREN'S HOSP & MED CTR - URGENT CARE - VAL VERDE | ||||||||
City: | LA VISTA | ||||||||
State: | NE | ||||||||
PostalCode: | 681282924 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4029557200 | ||||||||
FaxNumber: | 4029557250 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2011 | ||||||||
LastUpdateDate: | 08/23/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARNA | ||||||||
AuthorizedOfficialFirstName: | NANCY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING COMPLIANCE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 4029556775 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MPA, MS, FHFMA, CPC | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.