Provider Demographics
NPI:1699035931
Name:ALEGENT CREIGHTON CLINIC
Entity Type:Organization
Organization Name:ALEGENT CREIGHTON CLINIC
Other - Org Name:ALEGENT HEALTH CLINIC - CREIGHTON MEDICAL ASSOCIATES - RR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4328
Mailing Address - Street 1:12809 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2155
Mailing Address - Country:US
Mailing Address - Phone:402-343-4328
Mailing Address - Fax:402-343-4389
Practice Address - Street 1:12809 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2155
Practice Address - Country:US
Practice Address - Phone:402-343-4328
Practice Address - Fax:402-343-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty