Provider Demographics
NPI:1497781801
Name:MEHR, SAMUEL H
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:H
Last Name:MEHR
Suffix:
Gender:M
Credentials:
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 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-0460
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-398-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25649207U00000X, 2085R0202X
NE171442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1600115OtherUHC SHARE ALLIANCE
IA17830OtherBCBS
IA9914127Medicaid
IA5914127Medicaid
IA7914127Medicaid
NE03399OtherBCBS
11932OtherMIDLANDS
IA2914127Medicaid
IA6914127Medicaid
IA8914127Medicaid
IABM7320067OtherIA CONTROLLED SUBSTANCE
11932OtherMIDLANDS
E27131Medicare UPIN
NE03399OtherBCBS
IA7914127Medicaid
IA9914127Medicaid
IA300111289Medicare PIN
NE300033980Medicare PIN
IA17830Medicare PIN