Healthcare Provider Details

I. General information

NPI: 1730895368
Provider Name (Legal Business Name): KEVIN RAYMOND OGDEN CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2700 W NORFOLK AVE
NORFOLK NE
68701-4438
US

IV. Provider business mailing address

84451 539 AVE
MEADOW GROVE NE
68752-3530
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-4880
  • Fax:
Mailing address:
  • Phone: 402-750-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number2015011939
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number39
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: