=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760571640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREIGHTON AREA HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 11/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1503 MAIN ST
-----------------------------------------------------
City | CREIGHTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68729-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-358-5700
-----------------------------------------------------
Fax | 402-358-5769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 186
-----------------------------------------------------
City | CREIGHTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68729-0186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-358-5715
-----------------------------------------------------
Fax | 402-358-5769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. KIMBERLY J. HIXSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-358-5715
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------