Healthcare Provider Details

I. General information

NPI: 1073447215
Provider Name (Legal Business Name): BENJAMIN POLK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 9TH AVE
KEARNEY NE
68845-5830
US

IV. Provider business mailing address

1331 N COLORADO AVE
HASTINGS NE
68901-3119
US

V. Phone/Fax

Practice location:
  • Phone: 308-660-2190
  • Fax:
Mailing address:
  • Phone: 308-660-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: