Provider Demographics
NPI:1982773776
Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Other - Org Name:CHI HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4409
Mailing Address - Street 1:12809 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2155
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:12809 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2155
Practice Address - Country:US
Practice Address - Phone:402-398-6255
Practice Address - Fax:402-829-8513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098611Medicare Oscar/Certification