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General NPI Number Information
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NPI Number | 1710087036
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Entity Type | Organization
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Legal Business Name | KEARNEY UROLOGY CENTER P.C.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 123 W 31ST ST
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City | KEARNEY
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State | NE
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Zip | 68847-2916
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Country | US
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Telephone | 308-237-7719
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Fax | 308-236-6975
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Provider Business Mailing Address
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Address Line | 123 W 31ST ST
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City | KEARNEY
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State | NE
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Zip | 68847-2916
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Country | US
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Telephone | 308-237-7719
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Fax | 308-236-6975
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EARL K. LARSON
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Credential | M.D.
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Telephone | 308-237-7719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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