Provider Demographics
NPI:1417975483
Name:ALEGENT CREIGHTON HEALTH
Entity Type:Organization
Organization Name:ALEGENT CREIGHTON HEALTH
Other - Org Name:ALEGENT HEALTH LAKESIDE IDTF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO CHI HEALTH
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:402-343-4343
Mailing Address - Street 1:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-717-4377
Mailing Address - Fax:402-717-4317
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5060
Practice Address - Fax:402-758-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE98777Medicare ID - Type Unspecified