Provider Demographics
NPI:1225332430
Name:ALEGENT CREIGHTON CLINIC
Entity Type:Organization
Organization Name:ALEGENT CREIGHTON CLINIC
Other - Org Name:CHI HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4374
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:ATTN: CLINIC CREDENTIALING
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:1203 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1872
Practice Address - Country:US
Practice Address - Phone:712-527-3699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-03
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health