Provider Demographics
NPI:1629147418
Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Other - Org Name:ALEGENT HEALTH AT HOME MEDICAL EQUIPMENT AND INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:5428 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-2815
Mailing Address - Country:US
Mailing Address - Phone:402-898-8400
Mailing Address - Fax:402-898-8495
Practice Address - Street 1:5428 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-2815
Practice Address - Country:US
Practice Address - Phone:402-898-8400
Practice Address - Fax:402-898-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0429840002Medicare NSC