Healthcare Provider Details

I. General information

NPI: 1538183207
Provider Name (Legal Business Name): WESTERN ENT ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W 42ND ST SUITE 1100
SCOTTSBLUFF NE
69361-4669
US

IV. Provider business mailing address

2 W 42ND ST SUITE 1100
SCOTTSBLUFF NE
69361-4669
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3155
  • Fax: 308-635-2966
Mailing address:
  • Phone: 308-635-3155
  • Fax: 308-635-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JAMES D. MASSEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 308-635-3155