Organization
ALEGENT CREIGHTON HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE TIESI (SENIOR DIRECTOR)
(402) 343-4546
Entity
Organization
Contact information
Practice address
8248 S 96TH ST STE 101, LA VISTA, NE 68128-3126
(402) 717-9510
(402) 717-9511
Mailing address
8248 S 96TH ST STE 101, LA VISTA, NE 68128-3126
(402) 717-9510
(402) 717-9511
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026519115
—
NE
01
—
2932
NEBRASKA COMMUNITY PHARMACY PERMIT
NE
Enumeration date
05/15/2012
Last updated
10/23/2017
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