Healthcare Provider Details

I. General information

NPI: 1588012397
Provider Name (Legal Business Name): ALEGENT CREIGHTON CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 LAKESIDE HILLS CT SUITE 208
OMAHA NE
68130-4664
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 402-717-0820
  • Fax: 402-717-0830
Mailing address:
  • Phone: 402-398-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNE

VIII. Authorized Official

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