Healthcare Provider Details

I. General information

NPI: 1861941999
Provider Name (Legal Business Name): BRAD RODGERS MD FAMILY PRACTICE & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 3RD AVE
KEARNEY NE
68845-7820
US

IV. Provider business mailing address

102 3RD AVE
KEARNEY NE
68845-7820
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-2273
  • Fax: 308-237-4515
Mailing address:
  • Phone: 308-237-2273
  • Fax: 308-237-4515

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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNIE NOVACEK
Title or Position: OFFICE MANAGER
Credential:
Phone: 308-237-2273