Provider Demographics
NPI:1104939487
Name:ALEGENT HEALTH IMMANUEL MEDICAL CENTER
Entity type:Organization
Organization Name:ALEGENT HEALTH IMMANUEL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJTALEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4323
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:
Mailing Address - Fax:
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-572-2916
Practice Address - Fax:402-572-3544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096554Medicare Oscar/Certification
IAI7802Medicare PIN
NE096554Medicare Oscar/Certification