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General NPI Number Information
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NPI Number | 1104251628
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Entity Type | Organization
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Legal Business Name | ALEGENT CREIGHTON HEALTH
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 17201 WRIGHT ST STE 100
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City | OMAHA
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State | NE
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Zip | 68130-2042
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Country | US
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Telephone | 402-717-4760
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 772650
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 402-717-4377
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIM BRICKER
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Credential |
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Telephone | 541-610-8147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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