Healthcare Provider Details

I. General information

NPI: 1053799486
Provider Name (Legal Business Name): JAMES KENNETH POPOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES KENNETH PUTMAN M.D.

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLE CREEK XING STE 1
SIDNEY NE
69162-2902
US

IV. Provider business mailing address

1000 POLE CREEK CROSSING
SIDNEY NE
69162-2900
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5554
  • Fax:
Mailing address:
  • Phone: 308-254-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31424
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: