Provider Demographics
NPI:1518902709
Name:ECKERT, GREGORY G (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:ECKERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:ALEGENT MERCY HOSPITAL
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503
Practice Address - Country:US
Practice Address - Phone:712-328-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE217392085R0202X
IA340362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
26106OtherMIDLANDS
IA1247809Medicaid
21739OtherNE LICENSE #
IA0247809Medicaid
35310OtherNEBRASKA BCBS
IA2247809Medicaid
IA3247809Medicaid
34036OtherIA LICENSE #
BE7410739OtherIA CONTROLLED SUBSTANCE
40622OtherIOWA BCBS
IA4247809Medicaid
IA4247809Medicaid
40622OtherIOWA BCBS
NE274034Medicare PIN
IAI2204Medicare PIN
NENA1356006Medicare PIN
26106OtherMIDLANDS
G96511Medicare UPIN
IA3247809Medicaid