MEDICARE: CREIGHTON UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05338	OTHER		BCBS

General Provider Information

NPI Number	:	1457344178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREIGHTON UNIVERSITY

Provider Business Mailing Address
First Line	:	2500 CALIFORNIA PLZ
Second Line	:	SCHOOL OF DENTISTRY
City	:	OMAHA
State	:	NE
Zip	:	68178-0001
Country	:	US
Telephone Number	:	402-280-5020
Fax Number	:	402-280-5094

Provider Business Practice Location Address
First Line	:	2500 CALIFORNIA PLZ
Second Line	:	SCHOOL OF DENTISTRY
City	:	OMAHA
State	:	NE
Zip	:	68178-0001
Country	:	US
Telephone Number	:	402-280-5020
Fax Number	:	402-280-5094

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. PAUL C EDWARDS
Credential	:	DDS
Telephone Number	:	402-280-5020

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	08/22/2020

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Directions to “CREIGHTON UNIVERSITY ” Practice Location

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