Provider Demographics
NPI:1295816759
Name:ALEGENT HEALTH BERGAN MERCY HEALTH CENTER
Entity Type:Organization
Organization Name:ALEGENT HEALTH BERGAN MERCY HEALTH CENTER
Other - Org Name:ALEGENT HEALTH SURGERY CENTER - 117TH & CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:PO BOX 3548
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0548
Mailing Address - Country:US
Mailing Address - Phone:402-717-7889
Mailing Address - Fax:
Practice Address - Street 1:11704 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4375
Practice Address - Country:US
Practice Address - Phone:402-333-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC003261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
092105Medicare ID - Type Unspecified