1891875175 NPI number — HEAD AND NECK SURGICAL PARTNERS LLC

Table of content: (NPI 1891875175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891875175 NPI number — HEAD AND NECK SURGICAL PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAD AND NECK SURGICAL PARTNERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1891875175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 S 48TH ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-1277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-488-5812
Provider Business Mailing Address Fax Number:
402-488-1356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 S 48TH ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-488-5812
Provider Business Practice Location Address Fax Number:
402-488-1356
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFE
Authorized Official First Name:
DANA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
BOARD OF MANAGERS
Authorized Official Telephone Number:
402-484-4974

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASC022 , 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)





Copyright © 2007-2024 www.npivalidator.com