Provider Demographics
NPI:1578576112
Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Other - Org Name:ALEGENT HEALTH PSYCHIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:PO BOX 641130
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7130
Mailing Address - Country:US
Mailing Address - Phone:402-717-4390
Mailing Address - Fax:402-717-4280
Practice Address - Street 1:801 HARMONY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3106
Practice Address - Country:US
Practice Address - Phone:712-328-2609
Practice Address - Fax:712-328-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI4414Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER