Provider Demographics
NPI: | 1285138065 |
---|---|
Name: | CHI HEALTH CLINIC SPECIALTY, LLC |
Entity type: | Organization |
Organization Name: | CHI HEALTH CLINIC SPECIALTY, LLC |
Other - Org Name: | |
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: | |
Authorized Official - Phone: | 402-343-4477 |
Mailing Address - Street 1: | 7440 S 91ST ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LINCOLN |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68526-9797 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-421-0904 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 555 S 70TH ST |
Practice Address - Street 2: | |
Practice Address - City: | LINCOLN |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68510-2462 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-219-8000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ALEGENT CREIGHTON CLINIC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-03-19 |
Last Update Date: | 2023-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 207Q00000X, 208600000X | |
207RE0101X, 207RG0100X, 207RH0002X, 207RH0003X, 207RI0200X, 207RN0300X, 207RP1001X, 207VX0000X, 207XX0005X, 207Y00000X, 2080N0001X, 2085R0001X, 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207VX0000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |