MEDICARE: NILA M NOVOTNY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	17352	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	040007717	OTHER	NE	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3891	OTHER	NE	MIDLANDS CHOICE PPO
4	061181648-68601-A002	OTHER	NE	TRIWEST
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	04465	OTHER	NE	BLUE CROSS OF NEBRASKA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316934029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILA M NOVOTNY M.D.

Provider Business Mailing Address
First Line	:	4508 38TH ST
Second Line	:	SUITE #152
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1668
Country	:	US
Telephone Number	:	402-563-4500
Fax Number	:	402-563-3520

Provider Business Practice Location Address
First Line	:	4508 38TH ST
Second Line	:	SUITE #152
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1668
Country	:	US
Telephone Number	:	402-563-4500
Fax Number	:	402-563-3520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	02/12/2018

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Directions to “ NILA M NOVOTNY M.D.” Practice Location

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