1750487427 NPI number — FAMILY EAR NOSE & THROAT CLINIC PC

Table of content: (NPI 1750487427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750487427 NPI number — FAMILY EAR NOSE & THROAT CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EAR NOSE & THROAT CLINIC PC
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:
1750487427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6751 N 72ND ST
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68122-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-572-3165
Provider Business Mailing Address Fax Number:
402-572-3170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6751 N 72ND ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68122-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-572-3165
Provider Business Practice Location Address Fax Number:
402-572-3170
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAMEIER
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
402-572-3165

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 14446 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06552 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 065520002 . This is a "AUDIOLOGIST-RUTH FARRINGTON PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: DG0847 . This is a "RAILROAD MEDICARE LEGACY GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263505 . This is a "MEDICARE INDIVIDUAL PTAN FOR DR. PAUL SHERRERD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 040001751 . This is a "RAILROAD MEDICARE INDIVIDUAL PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 098004 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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