Provider Demographics
NPI:1548287907
Name:ALEGENT CREIGHTON CLINIC
Entity type:Organization
Organization Name:ALEGENT CREIGHTON CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM SVP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-343-4477
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-717-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098675OtherMEDICARE PTAN
NE098691OtherMEDICARE PTAN
NE098676OtherMEDICARE PTAN
NE098688OtherMEDICARE PTAN
NE098680OtherMEDICARE PTAN
NE098682OtherMEDICARE PTAN
098684OtherMEDICARE PTAN
NE099398OtherMEDICARE PTAN
NE098672OtherMEDICARE PTAN
NE098678OtherMEDICARE PTAN
NE098694OtherMEDICARE PTAN
NE098695OtherMEDICARE PTAN
NE098673OtherMEDICARE PTAN
NE098684OtherMEDICARE PTAN
NE098685OtherMEDICARE PTAN
NE098686OtherMEDICARE PTAN