Provider Demographics
NPI:1427056100
Name:COLONOSCOPY CENTER INC
Entity type:Organization
Organization Name:COLONOSCOPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-1122
Mailing Address - Street 1:9850 NICHOLAS STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-343-1122
Mailing Address - Fax:402-343-1177
Practice Address - Street 1:9850 NICHOLAS STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-343-1122
Practice Address - Fax:402-343-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC038261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0570762Medicaid
IA98448OtherBCBS OF IOWA
P00106867OtherRR MEDICARE PALMETO GPA
NED01791OtherBCBS OF NEBRASKA
NE10025038900Medicaid
NE10025038900Medicaid