1710087036 NPI number — KEARNEY UROLOGY CENTER P.C.

Table of content: (NPI 1710087036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710087036 NPI number — KEARNEY UROLOGY CENTER P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEARNEY UROLOGY CENTER P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710087036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 W 31ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68847-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-237-7719
Provider Business Mailing Address Fax Number:
308-236-6975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 W 31ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-237-7719
Provider Business Practice Location Address Fax Number:
308-236-6975
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
EARL
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
308-237-7719

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100356430A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6266 . This is a "S.F. HOWE-MIDLANDS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 01500 . This is a "LAROY WILLIAMS-BCBS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 30621 . This is a "DR. S.F. HOWE-BCBS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 6267 . This is a "E.K. LARSON-MIDLANDS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100120100A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13026 . This is a "L.E. WILLIAMS-MIDLANDS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1671 . This is a "DR. E.K. LARSON-BCBS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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