Provider Demographics
NPI:1275967051
Name:ROSE SALTER MEDICAL RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:ROSE SALTER MEDICAL RESEARCH FOUNDATION
Other - Org Name:ROSE SALTER DIABETES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:RENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-578-1580
Mailing Address - Street 1:660 S 85TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4206
Mailing Address - Country:US
Mailing Address - Phone:402-578-1580
Mailing Address - Fax:402-280-5245
Practice Address - Street 1:601 N. 30TH ST.
Practice Address - Street 2:SUITE 6715
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-578-1580
Practice Address - Fax:402-280-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17167207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB69703Medicare UPIN