Healthcare Provider Details

I. General information

NPI: 1760571640
Provider Name (Legal Business Name): CREIGHTON AREA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 MAIN ST
CREIGHTON NE
68729-3007
US

IV. Provider business mailing address

PO BOX 186
CREIGHTON NE
68729-0186
US

V. Phone/Fax

Practice location:
  • Phone: 402-358-5700
  • Fax: 402-358-5769
Mailing address:
  • Phone: 402-358-5715
  • Fax: 402-358-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY J. HIXSON
Title or Position: CFO
Credential:
Phone: 402-358-5715