Provider Demographics
NPI:1417263591
Name:STATEWIDE MEDICALEQUIPMENT, INC
Entity Type:Organization
Organization Name:STATEWIDE MEDICALEQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENTS
Authorized Official - Middle Name:U
Authorized Official - Last Name:AKARA, MT ASCP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-697-1985
Mailing Address - Street 1:7511 S 36TH ST
Mailing Address - Street 2:STE 6
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1244
Mailing Address - Country:US
Mailing Address - Phone:402-697-1985
Mailing Address - Fax:402-738-1985
Practice Address - Street 1:7511 S 36TH ST
Practice Address - Street 2:STE 6
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1244
Practice Address - Country:US
Practice Address - Phone:402-697-1985
Practice Address - Fax:402-738-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28D1077080291U00000X
NE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08871OtherBLUECROSS BLUESHIELD
NEF245676OtherMIDLAND CHOICE
NE10025079400Medicaid
NE08871OtherBLUECROSS BLUESHIELD