Healthcare Provider Details

I. General information

NPI: 1982773776
Provider Name (Legal Business Name): ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12809 W DODGE RD
OMAHA NE
68154-2155
US

IV. Provider business mailing address

12809 W DODGE RD
OMAHA NE
68154-2155
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-6255
  • Fax: 402-829-8513
Mailing address:
  • Phone: 402-398-6255
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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