Healthcare Provider Details

I. General information

NPI: 1083139224
Provider Name (Legal Business Name): ALEGENT HEALTH QUICK CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W BROADWAY
COUNCIL BLUFFS IA
51501-3602
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 800-253-4368
  • Fax: 712-256-3456
Mailing address:
  • Phone: 14023986255
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH JANKUSKI
Title or Position: COO
Credential:
Phone: 402-343-4409