Provider Demographics
NPI:1174631261
Name:RYBERG, ARDITH A (MD)
Entity Type:Individual
Prefix:
First Name:ARDITH
Middle Name:A
Last Name:RYBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S 113TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1857
Mailing Address - Country:US
Mailing Address - Phone:402-334-9171
Mailing Address - Fax:402-895-5060
Practice Address - Street 1:801 HARMONY ST
Practice Address - Street 2:SUITE 408
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3106
Practice Address - Country:US
Practice Address - Phone:712-256-6160
Practice Address - Fax:402-895-5060
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19489208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209767946Medicaid
NE32328OtherBLUE CROSS BLUE SHIELD
NE10025492800Medicaid
IA3507293Medicaid
NE281091Medicare PIN
MO209767946Medicaid
IA3507293Medicaid
NEG68592Medicare UPIN