Healthcare Provider Details

I. General information

NPI: 1124121066
Provider Name (Legal Business Name): CHILDREN & ADOLESCENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 N KANSAS CHILDREN & ADOLESCENT CLINIC PC
HASTINGS NE
68901
US

IV. Provider business mailing address

2115 N KANSAS CHILDREN & ADOLESCENT CLINIC PC
HASTINGS NE
68901
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-6828
  • Fax:
Mailing address:
  • Phone: 402-463-6828
  • Fax: 402-463-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KEN A ZOUCHA
Title or Position: MD/OWNER
Credential: MD
Phone: 402-463-6828