Provider Demographics
NPI:1215038625
Name:MIDWEST EAR NOSE & THROAT SPECIALISTS PC
Entity type:Organization
Organization Name:MIDWEST EAR NOSE & THROAT SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VAUGHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-463-2431
Mailing Address - Street 1:2115 N KANSAS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-463-2431
Mailing Address - Fax:402-463-2486
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-463-2431
Practice Address - Fax:402-463-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01949OtherBCBS
NE=========00Medicaid
NE01949OtherBCBS