NPIMap

Organization Active NPI

State of Nebraska Dept of Admin Services

  • Health Service Clinic/Center
  • Omaha, NE
National Provider Identifier
1447091004
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Practice address
2610 N 20TH St E
Omaha, NE 68110
Phone
(402) 522-7136
Fax
(402) 595-2822
NPI assigned
Jun 5, 2024
Organization subpart
Yes
Parent organization
STATE OF NEBRASKA DEPT OF ADMIN SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Cassandra Jane Putnam
Title
Health Care Administrator
Phone
(402) 479-5630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

2610 N 20TH St E
Omaha, NE 68110

Mailing address

2610 N 20TH St E
Omaha, NE 68110
Phone (402) 522-7136

Other names 1

  • NDCS Nebraska Correctional Youth Facility Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D2022060Nebraska Correctional Youth Facility2610 North 20TH Street East, Omaha, NE 68110Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Western Nebraska Vetera27 organizations share this tax ID, including this one
Part of
Western Nebraska Vetera

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

2610 N 20th St E
Omaha, NE 68110
Phone (402) 522-7136

NPI Registry JSON

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1447091004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 N 20TH ST E",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68110",
            "telephone_number": "402-522-7136",
            "fax_number": "402-595-2822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 N 20TH ST E",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68110",
            "telephone_number": "402-522-7136",
            "fax_number": "402-595-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEBRASKA DEPT OF ADMIN SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEBRASKA DEPT OF ADMIN SERVICES",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "PUTNAM",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "HEALTH CARE ADMINISTRATOR",
        "authorized_official_telephone_number": "402-479-5630"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NDCS Nebraska Correctional Youth Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.