Provider Demographics
NPI:1194880740
Name:DIRENZO-COFFEY, GINA (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:DIRENZO-COFFEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:DIRENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:14080 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7513
Practice Address - Country:US
Practice Address - Phone:402-778-6900
Practice Address - Fax:402-778-6917
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21462208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1200589Medicaid
NE35173OtherMIDLANDS CHOICE
IA0538587Medicaid
IA1538587Medicaid
NE1200598Medicaid
NE1200599Medicaid
NE1200600Medicaid
NE1201446Medicaid
NE1201455Medicaid
NE03484OtherBCBS
NE1200597Medicaid
IA2538587Medicaid
IA0538587Medicaid