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General NPI Number Information
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NPI Number | 1285873240
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Entity Type | Organization
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Legal Business Name | PLATTE VALLEY PAIN CARE PC
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 2908 W 39TH ST SUITE D
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City | KEARNEY
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State | NE
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Zip | 68845-1225
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Country | US
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Telephone | 308-236-0507
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Fax | 308-236-0509
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Provider Business Mailing Address
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Address Line | PO BOX 310255
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City | DES MOINES
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State | IA
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Zip | 50331-0255
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Country | US
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Telephone | 308-236-0507
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Fax | 308-236-0509
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN SCOTT BALTER
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Credential | MD
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Telephone | 308-236-0507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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