Provider Demographics
NPI:1285873240
Name:PLATTE VALLEY PAIN CARE PC
Entity type:Organization
Organization Name:PLATTE VALLEY PAIN CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-236-0507
Mailing Address - Street 1:PO BOX 310255
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50331-0255
Mailing Address - Country:US
Mailing Address - Phone:308-236-0507
Mailing Address - Fax:308-236-0509
Practice Address - Street 1:2908 W 39TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1225
Practice Address - Country:US
Practice Address - Phone:308-236-0507
Practice Address - Fax:308-236-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1274Medicare PIN
NE6315770001Medicare NSC