Provider Demographics
NPI:1114958337
Name:CREIGHTON SAINT JOSEPH REGIONAL HEALTH CARE SYSTEM, L.L.C.
Entity Type:Organization
Organization Name:CREIGHTON SAINT JOSEPH REGIONAL HEALTH CARE SYSTEM, L.L.C.
Other - Org Name:CREIGHTON UNIVERSITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 849791
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9791
Mailing Address - Country:US
Mailing Address - Phone:402-449-4342
Mailing Address - Fax:402-449-5020
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-449-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE260010282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01400357Medicaid
IN100039180AMedicaid
FL180493700Medicaid
MI8033723Medicaid
CAXHSP32674Medicaid
000426OtherHUMANA
00194OtherBCBS OF NEBRASKA
LA1740853Medicaid
KS100106590AMedicaid
AZ372061Medicaid
CO95002366Medicaid
ID002180400Medicaid
76278OtherCOVENTRY HEALTH CARE KANS
ALHOS00030NMedicaid
IA0992917Medicaid
AR130746105Medicaid
636781020OtherAETNA US HEALTHCARE (NATI
GA00524939XMedicaid
CAXHSP42674Medicaid
ALHOS00030NMedicaid
GA00524939XMedicaid