NPIMap

Organization Active NPI

Grandgen, LLC

Doing business as Devenu Medical Rejuvenation Center

  • Specialist
  • Omaha, NE
National Provider Identifier
1326351651
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
23224 Issued in IA
Legal business name
GRANDGEN, LLC
Doing business as
Devenu Medical Rejuvenation Center
Practice address
9802 Nicholas St
Suite 305
Omaha, NE 68114-2167
Phone
(402) 397-2300
Fax
(402) 397-2303
NPI assigned
Jul 15, 2010
Last updated
Jul 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jon Fulcher
Title
President
Phone
(402) 445-6173

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 23224 IA Primary

Addresses

Primary practice location

9802 Nicholas St
Suite 305
Omaha, NE 68114-2167

Mailing address

9802 Nicholas St
Suite 305
Omaha, NE 68114-2167
Phone (402) 397-2300

Other names 1

  • Devenu Medical Rejuvenation Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1326351651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9802 NICHOLAS ST",
            "address_2": "SUITE 305",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142167",
            "telephone_number": "402-397-2300",
            "fax_number": "402-397-2303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9802 NICHOLAS ST",
            "address_2": "SUITE 305",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142167",
            "telephone_number": "402-397-2300",
            "fax_number": "402-397-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDGEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-15",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "FULCHER",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-445-6173",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "23224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devenu Medical Rejuvenation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.