Healthcare Provider Details

I. General information

NPI: 1750487427
Provider Name (Legal Business Name): FAMILY EAR NOSE & THROAT CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 N 72ND ST SUITE 207
OMAHA NE
68122-1746
US

IV. Provider business mailing address

6751 N 72ND ST SUITE 207
OMAHA NE
68122-1746
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-3165
  • Fax: 402-572-3170
Mailing address:
  • Phone: 402-572-3165
  • Fax: 402-572-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number221
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number14446
License Number StateNE

VIII. Authorized Official

Name: JILL DAMEIER
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-572-3165