Provider Demographics
NPI:1457305906
Name:MIDLANDS DIABETES EDUCATION AND SELF HELP CENTER
Entity Type:Organization
Organization Name:MIDLANDS DIABETES EDUCATION AND SELF HELP CENTER
Other - Org Name:DIABETES EDUCATION CENTER OF THE MIDLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-399-0777
Mailing Address - Street 1:2910 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3213
Mailing Address - Country:US
Mailing Address - Phone:402-399-0777
Mailing Address - Fax:
Practice Address - Street 1:2910 S 84TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3213
Practice Address - Country:US
Practice Address - Phone:402-399-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE81000OtherBCBS OF NE GROUP NUMBER
NE=========13Medicaid
NE=========13Medicaid