Healthcare Provider Details

I. General information

NPI: 1720030356
Provider Name (Legal Business Name): MIDWEST EAR, NOSE & THROAT CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S 144TH ST SUITE 105
OMAHA NE
68144-5225
US

IV. Provider business mailing address

2727 S 144TH ST SUITE 105
OMAHA NE
68144-5225
US

V. Phone/Fax

Practice location:
  • Phone: 402-778-5200
  • Fax: 402-778-5216
Mailing address:
  • Phone: 402-778-5200
  • Fax: 402-778-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD B SIMONS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-778-5200