Healthcare Provider Details

I. General information

NPI: 1841737418
Provider Name (Legal Business Name): KEARNEY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 33 ST
KEARNEY NE
68845-3456
US

IV. Provider business mailing address

211 W 33 ST
KEARNEY NE
68845-3456
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2141
  • Fax: 308-234-7582
Mailing address:
  • Phone: 308-865-2141
  • Fax: 308-234-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PEGGY KAY DOBISH
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 308-865-2141