Healthcare Provider Details

I. General information

NPI: 1245104223
Provider Name (Legal Business Name): KHL-RO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 22ND AVE
KEARNEY NE
68845
US

IV. Provider business mailing address

909 22ND AVE
KEARNEY NE
68845
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN ROUSEK
Title or Position: CEO
Credential: PHD
Phone: 402-420-7000