Healthcare Provider Details

I. General information

NPI: 1205968112
Provider Name (Legal Business Name): ALEGENT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 S 142ND ST
OMAHA NE
68138-6804
US

IV. Provider business mailing address

PO BOX 642117
OMAHA NE
68164-8117
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-4200
  • Fax:
Mailing address:
  • Phone: 402-717-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EVERT KUIPER
Title or Position: CEO
Credential:
Phone: 402-343-4420