Healthcare Provider Details

I. General information

NPI: 1861176604
Provider Name (Legal Business Name): TANNER JAMES KOVACS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 22ND AVE # NE
KEARNEY NE
68845-2206
US

IV. Provider business mailing address

804 22ND AVE # NE68845
KEARNEY NE
68845-2206
US

V. Phone/Fax

Practice location:
  • Phone: 308-455-3600
  • Fax:
Mailing address:
  • Phone: 308-455-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3144
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: