1871673384 NPI number — EAR, NOSE & THROAT SPECIALTIES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871673384 NPI number — EAR, NOSE & THROAT SPECIALTIES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR, NOSE & THROAT SPECIALTIES, 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:
6
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:
1871673384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/25/2023
NPI Reactivation Date:
09/01/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 A ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-4970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-488-5600
Provider Business Mailing Address Fax Number:
402-488-7649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5055 A ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-4970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-488-5600
Provider Business Practice Location Address Fax Number:
402-488-7649
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CEDERBERG
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSCIAN/OWNER
Authorized Official Telephone Number:
402-488-5600

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , 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)





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