Provider Demographics
NPI:1700881414
Name:REICHERT, JAMES CHARLES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:REICHERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2255 S 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2573
Practice Address - Country:US
Practice Address - Phone:402-717-3390
Practice Address - Fax:402-717-3393
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053809L207Q00000X
NE25432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02332814OtherNY MEDICAID
OH2351306OtherOH MEDICAID
PAP000571OtherGATEWAY
PA159112OtherUNISON
PA080188193OtherRR MEDICARE
PA0015346820009Medicaid
PA781829OtherBLUE SHIELD
PA323632OtherUPMC
NY00026143101OtherUNIVERA
PA851458OtherAETNA
PA080188193OtherRR MEDICARE
PA0015346820009Medicaid