Healthcare Provider Details

I. General information

NPI: 1992795629
Provider Name (Legal Business Name): ENT PHYSICIANS OF KEARNEY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WEST 39TH STREET
KEARNEY NE
68845-8001
US

IV. Provider business mailing address

615 WEST 39TH STREET
KEARNEY NE
68845-8001
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2277
  • Fax: 308-865-2523
Mailing address:
  • Phone: 308-865-2277
  • Fax: 308-865-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: REGGIE D DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 308-865-2277