Healthcare Provider Details

I. General information

NPI: 1982158887
Provider Name (Legal Business Name): MCKEAG PAIN SOLUTIONS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 56TH ST STE C2
KEARNEY NE
68847-8628
US

IV. Provider business mailing address

920 E 56TH ST STE C2
KEARNEY NE
68847-8628
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-9696
  • Fax: 308-237-4517
Mailing address:
  • Phone: 308-237-9696
  • Fax: 308-237-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number22010
License Number StateNE

VIII. Authorized Official

Name: DR. BURT J. MCKEAG
Title or Position: OWNER
Credential: M.D.
Phone: 308-237-9696