Provider Demographics
NPI:1538345533
Name:JANET GRANGE, MD, PC
Entity type:Organization
Organization Name:JANET GRANGE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-934-9323
Mailing Address - Street 1:401 E GOLD COAST RD
Mailing Address - Street 2:SUITE 329
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4194
Mailing Address - Country:US
Mailing Address - Phone:402-934-9323
Mailing Address - Fax:402-934-9471
Practice Address - Street 1:401 E GOLD COAST RD
Practice Address - Street 2:SUITE 329
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4194
Practice Address - Country:US
Practice Address - Phone:402-934-9323
Practice Address - Fax:402-934-9471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE34173OtherBCBS OF NEBRASKA #
NE17-81009OtherUNITED HEALTH CARE #
IA2224212Medicaid
IA2224212Medicaid
IA2224212Medicaid
NE099003JAMedicare PIN
IAI8956Medicare PIN
NE273680GRMedicare PIN
NE=========00Medicaid
IAI8957Medicare PIN