Provider Demographics
NPI:1396050100
Name:CSJ PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:CSJ PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, OPS FINANCE & PMO, TENET
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-6960
Mailing Address - Street 1:3213 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1832
Mailing Address - Country:US
Mailing Address - Phone:402-509-8410
Mailing Address - Fax:402-346-9448
Practice Address - Street 1:3213 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1832
Practice Address - Country:US
Practice Address - Phone:402-509-8410
Practice Address - Fax:402-346-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty