Provider Demographics
NPI:1760527683
Name:CREIGHTON UNIVERSITY
Entity Type:Organization
Organization Name:CREIGHTON UNIVERSITY
Other - Org Name:CREIGHTON MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-280-5248
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 N 27TH ST
Practice Address - Street 2:CRISS II
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0023
Practice Address - Country:US
Practice Address - Phone:402-280-4382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17039Medicare PIN
NE094483Medicare PIN