Provider Demographics
NPI:1649614389
Name:ALAN D JENSEN MD P C
Entity type:Organization
Organization Name:ALAN D JENSEN MD P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PREIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-6060
Mailing Address - Street 1:8761 W CENTER RD STE B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2166
Mailing Address - Country:US
Mailing Address - Phone:402-397-6060
Mailing Address - Fax:402-398-0336
Practice Address - Street 1:8761 W CENTER RD STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2166
Practice Address - Country:US
Practice Address - Phone:402-397-6060
Practice Address - Fax:402-398-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17820261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center