Healthcare Provider Details

I. General information

NPI: 1518270883
Provider Name (Legal Business Name): NEOSOM CLINICS DBA ENT & SLEEP MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 OHMS LN
EDINA MN
55439-2148
US

IV. Provider business mailing address

700 MEDICAL CENTER DR SUITE 101
NEWTON KS
67114-9013
US

V. Phone/Fax

Practice location:
  • Phone: 612-465-0123
  • Fax: 952-843-4301
Mailing address:
  • Phone: 316-283-2828
  • Fax: 316-283-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04-32263
License Number StateKS

VIII. Authorized Official

Name: BARRY PAUL KIMBERLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 612-465-0123