Provider Demographics
NPI:1154406791
Name:EAR, NOSE & THROAT SPECIALTIES, P.C.
Entity type:Organization
Organization Name:EAR, NOSE & THROAT SPECIALTIES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CEDERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-488-5600
Mailing Address - Street 1:4800 HOSPITAL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-6906
Mailing Address - Country:US
Mailing Address - Phone:402-228-1316
Mailing Address - Fax:402-228-1741
Practice Address - Street 1:4800 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-6906
Practice Address - Country:US
Practice Address - Phone:402-228-1316
Practice Address - Fax:402-228-1741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR, NOSE & THROAT SPECIALTIES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2023-09-01
Deactivation Date:2023-07-25
Deactivation Code:
Reactivation Date:2023-09-01
Provider Licenses
StateLicense IDTaxonomies
NE207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025360600Medicaid
NE092620Medicare ID - Type Unspecified