Healthcare Provider Details

I. General information

NPI: 1922055953
Provider Name (Legal Business Name): NEW WEST SPORTS MEDICINE & ORTHOPAEDIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W. 35TH ST
KEARNEY NE
68845-2886
US

IV. Provider business mailing address

2810 W 35TH ST
KEARNEY NE
68845-2909
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2570
  • Fax: 308-865-2508
Mailing address:
  • Phone: 308-865-2570
  • Fax: 308-865-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL SWANSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 308-865-2570