Provider Demographics
NPI:1992795629
Name:ENT PHYSICIANS OF KEARNEY, P.C.
Entity type:Organization
Organization Name:ENT PHYSICIANS OF KEARNEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-865-2277
Mailing Address - Street 1:615 WEST 39TH STREET
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8001
Mailing Address - Country:US
Mailing Address - Phone:308-865-2277
Mailing Address - Fax:308-865-2523
Practice Address - Street 1:615 WEST 39TH STREET
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8001
Practice Address - Country:US
Practice Address - Phone:308-865-2277
Practice Address - Fax:308-865-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE0961160001Medicare NSC
NE=========13Medicaid