Provider Demographics
NPI:1235549726
Name:ANDORF-BLUM LTD
Entity Type:Organization
Organization Name:ANDORF-BLUM LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-476-7557
Mailing Address - Street 1:4444 SOUTH 86TH ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:4444 SOUTH 86TH ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11590132OtherCAQH
NE10025262900Medicaid
NE278893Medicare PIN