Healthcare Provider Details

I. General information

NPI: 1538163092
Provider Name (Legal Business Name): CENTRAL NEBRASKA ORTHOPEDICS & SPORTS MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE STE 200
GRAND ISLAND NE
68803-4984
US

IV. Provider business mailing address

620 N DIERS AVE STE 200
GRAND ISLAND NE
68803-4984
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-5400
  • Fax: 308-384-5201
Mailing address:
  • Phone: 308-384-5400
  • Fax: 308-384-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15386
License Number StateNE

VIII. Authorized Official

Name: PHILIP M CAHOY
Title or Position: PHYSICIAN
Credential: MD
Phone: 308-384-5400