Provider Demographics
NPI:1619240918
Name:ALEGENT CREIGHTON HEALTH
Entity Type:Organization
Organization Name:ALEGENT CREIGHTON HEALTH
Other - Org Name:CHI HEALTH CLINIC PLAINVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJTALEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4343
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NE
Mailing Address - Zip Code:68769-0490
Mailing Address - Country:US
Mailing Address - Phone:402-582-4245
Mailing Address - Fax:402-582-3940
Practice Address - Street 1:704 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NE
Practice Address - Zip Code:68769-2047
Practice Address - Country:US
Practice Address - Phone:402-582-4245
Practice Address - Fax:402-582-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2115OtherMEDICARE PTAN