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General NPI Number Information
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NPI Number | 1952660615
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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 | 05/15/2012
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 8248 S 96TH ST STE 101
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City | LA VISTA
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State | NE
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Zip | 68128-3126
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Country | US
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Telephone | 402-717-9510
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Fax | 402-717-9511
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Provider Business Mailing Address
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Address Line | 8248 S 96TH ST STE 101
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City | LA VISTA
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State | NE
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Zip | 68128-3126
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Country | US
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Telephone | 402-717-9510
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Fax | 402-717-9511
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Authorized Official
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Title or Position | SENIOR DIRECTOR
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Name | MIKE TIESI
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Credential |
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Telephone | 402-343-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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