Provider Demographics
NPI:1871780890
Name:CREIGHTON UNIVERSITY
Entity type:Organization
Organization Name:CREIGHTON UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-280-1133
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2159
Mailing Address - Country:US
Mailing Address - Phone:402-280-5877
Mailing Address - Fax:
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:712-328-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47666Medicare PIN
IA55846Medicare PIN
IA55676Medicare PIN
IA41947Medicare PIN
IA44836Medicare PIN
IA55702Medicare PIN
IA55826Medicare PIN
IA41937Medicare PIN
IA55659Medicare PIN
IA41959Medicare PIN
IA41982Medicare PIN
IA55756Medicare PIN
IA55794Medicare PIN
IA41921Medicare PIN
IA44804Medicare PIN
IA55688Medicare PIN
IAI5707Medicare PIN