Healthcare Provider Details

I. General information

NPI: 1801808159
Provider Name (Legal Business Name): HEARTLAND EAR, NOSE & THROAT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E 23RD ST
FREMONT NE
68025-2414
US

IV. Provider business mailing address

1550 E 23RD ST
FREMONT NE
68025-2414
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-2623
  • Fax: 402-721-2339
Mailing address:
  • Phone: 402-721-2623
  • Fax: 402-721-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number22720
License Number StateNE

VIII. Authorized Official

Name: TIMOTHY C KUO
Title or Position: PHYSICIAN/MANAGING PARTNER
Credential: MD
Phone: 402-721-2623