Provider Demographics
NPI:1215066568
Name:ALEGENT HEALTH QUICK CARE LLC
Entity type:Organization
Organization Name:ALEGENT HEALTH QUICK CARE LLC
Other - Org Name:
Other - Org Type:
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 1:7261 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 1:3410 N 156TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2020
Practice Address - Country:US
Practice Address - Phone:888-333-7520
Practice Address - Fax:402-614-5733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-04
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099928Medicare PIN