Provider Demographics
NPI:1245413483
Name:UNIVERSITY OF NEBRASKA BOARD OF REGENTS
Entity Type:Organization
Organization Name:UNIVERSITY OF NEBRASKA BOARD OF REGENTS
Other - Org Name:HUMAN GENETIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PATIENT INFORMATION
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-559-7232
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-5070
Mailing Address - Fax:
Practice Address - Street 1:444 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3727
Practice Address - Country:US
Practice Address - Phone:402-559-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNROE-MEYER INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-11
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025554500Medicaid
1164645818OtherNPI