Provider Demographics
NPI:1699868596
Name:EAR NOSE & THROAT - HEAD AND NECK SURGERY P.C.
Entity type:Organization
Organization Name:EAR NOSE & THROAT - HEAD AND NECK SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DOBLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-393-7050
Mailing Address - Street 1:11704 W CENTER RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4375
Mailing Address - Country:US
Mailing Address - Phone:402-393-7050
Mailing Address - Fax:402-393-2814
Practice Address - Street 1:11704 W CENTER RD
Practice Address - Street 2:SUITE 211
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4375
Practice Address - Country:US
Practice Address - Phone:402-393-7050
Practice Address - Fax:402-393-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18235207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE97053OtherBLUECROSS/BLUE SHIELD IA
NE0957373Medicaid
NE02621OtherBLUECROSS/BLUE SHIELD NE
NE02621OtherBLUECROSS/BLUE SHIELD NE
NE0957373Medicaid
NE=========OtherFEDERAL TAX NUMBER
NE=========OtherTRICARE
NE0957373Medicaid
NE099956Medicare PIN