1538216791 NPI number — MS. MARY A GOSSMAN M.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538216791 NPI number — MS. MARY A GOSSMAN M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSSMAN
Provider First Name:
MARY
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1538216791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N 30TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68131-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-498-6509
Provider Business Mailing Address Fax Number:
402-498-6357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68131-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-498-6509
Provider Business Practice Location Address Fax Number:
402-498-6357
Provider Enumeration Date:
01/03/2007

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: 231H00000X , with the licence number:  27 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2585083 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36841 . This is a "BCBS BT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 4585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585083 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1585083 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3585083 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2585075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36842 . This is a "BCBS ENT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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