Provider Demographics
NPI:1649304411
Name:JAY A. RICH M.D. AND ASSOCIATES P.C.
Entity type:Organization
Organization Name:JAY A. RICH M.D. AND ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-431-4080
Mailing Address - Street 1:11920 BURT ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1598
Mailing Address - Country:US
Mailing Address - Phone:402-431-4080
Mailing Address - Fax:402-951-2747
Practice Address - Street 1:11920 BURT ST
Practice Address - Street 2:SUITE 165
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1598
Practice Address - Country:US
Practice Address - Phone:402-431-4080
Practice Address - Fax:402-951-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7131041C0700X
NE139142084P0800X
NE346101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099946Medicare PIN