Provider Demographics
NPI:1760571640
Name:CREIGHTON AREA HEALTH SERVICES
Entity Type:Organization
Organization Name:CREIGHTON AREA HEALTH SERVICES
Other - Org Name:CREIGHTON AREA HEALTH SERVICES PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-358-5715
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:NE
Mailing Address - Zip Code:68729-0186
Mailing Address - Country:US
Mailing Address - Phone:402-358-5715
Mailing Address - Fax:402-358-5769
Practice Address - Street 1:1503 MAIN ST
Practice Address - Street 2:
Practice Address - City:CREIGHTON
Practice Address - State:NE
Practice Address - Zip Code:68729-3007
Practice Address - Country:US
Practice Address - Phone:402-358-5700
Practice Address - Fax:402-358-5769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREIGHTON AREA HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08607OtherCRNAS (BCBS OF NE)
NE04349OtherPROF SVCS (BCBS OF NE)
NE10025004300Medicaid
NE10025363700Medicaid
NE04349OtherPROF SVCS (BCBS OF NE)
NE=========12Medicaid
NE08607OtherCRNAS (BCBS OF NE)