Provider Demographics
NPI:1205037579
Name:ANTONIO B SAQUETON PC
Entity Type:Organization
Organization Name:ANTONIO B SAQUETON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEYRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-978-5151
Mailing Address - Street 1:PO BOX 460607
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-0607
Mailing Address - Country:US
Mailing Address - Phone:402-978-5151
Mailing Address - Fax:402-341-3616
Practice Address - Street 1:4115 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68147-1059
Practice Address - Country:US
Practice Address - Phone:402-978-5151
Practice Address - Fax:402-341-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025273600Medicaid
NE099240Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER