Basic Information
Provider Information | |||||||||
NPI: | 1982091583 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SIREF | ||||||||
FirstName: | ANDREW | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7500 MERCY RD | ||||||||
Address2: |   | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681242319 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4027172875 | ||||||||
FaxNumber: | 4027172875 | ||||||||
Practice Location | |||||||||
Address1: | 7500 MERCY RD | ||||||||
Address2: |   | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681242319 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4027172875 | ||||||||
FaxNumber: | 4027172875 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/21/2015 | ||||||||
LastUpdateDate: | 04/25/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/25/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 34412 | NE | N |   | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | MD-49646 | IA | N |   | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 75375-20 | WI | N |   | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZH0000X | MD-49646 | IA | N |   | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZH0000X | 34412 | NE | N |   | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | MD-49646 | NE | N |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 75375-20 | WI | N |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207ZP0102X | 34412 | NE | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.