Provider Demographics
NPI:1558457440
Name:ALEGENT CREIGHTON HEALTH
Entity Type:Organization
Organization Name:ALEGENT CREIGHTON HEALTH
Other - Org Name:CHI HEALTH PHARMACY - BERGAN MERCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4546
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:STE 110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-398-6781
Mailing Address - Fax:402-398-6036
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:STE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-398-6781
Practice Address - Fax:402-398-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1472332B00000X, 3336C0003X
333600000X
IA47033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026519113Medicaid
2053673OtherPK
IA0220637Medicaid
NE1472OtherNEBRASKA COMMUNITY PHARMACY PERMIT
NE10026519113Medicaid
NE10026519113Medicaid