Healthcare Provider Details

I. General information

NPI: 1598811069
Provider Name (Legal Business Name): ALEGENT CREIGHTON CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MERCY DR
COUNCIL BLUFFS IA
51503-3128
US

IV. Provider business mailing address

7261 MERCY RD ATTN: CREDENTIALING
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 855-524-4001
  • Fax:
Mailing address:
  • Phone: 402-398-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID PRITZA
Title or Position: SVP
Credential: MD
Phone: 402-343-4477