Provider Demographics
NPI:1124022983
Name:ATKINS, BROADUS ZANE (MD)
Entity type:Individual
Prefix:DR
First Name:BROADUS
Middle Name:ZANE
Last Name:ATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 22ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2226
Mailing Address - Country:US
Mailing Address - Phone:308-865-2263
Mailing Address - Fax:308-865-2541
Practice Address - Street 1:816 22ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2226
Practice Address - Country:US
Practice Address - Phone:308-865-2263
Practice Address - Fax:308-865-2541
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60774388208G00000X
NE36228208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124022983Medicaid
WA8971060OtherMEDICARE PIN
NCI05953Medicare UPIN
WA8971060OtherMEDICARE PIN