Provider Demographics
NPI:1427317205
Name:ALEGENT CREIGHTON HEALTH
Entity type:Organization
Organization Name:ALEGENT CREIGHTON HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4546
Mailing Address - Street 1:13315 W CENTER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3449
Mailing Address - Country:US
Mailing Address - Phone:402-717-9410
Mailing Address - Fax:402-717-9411
Practice Address - Street 1:13315 W CENTER RD STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3449
Practice Address - Country:US
Practice Address - Phone:402-717-9410
Practice Address - Fax:402-717-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2936OtherCOMMUNITY PHARMACY PERMIT
NE10026519116Medicaid
NE7482690012Medicare NSC