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General NPI Number Information
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NPI Number | 1750487427
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Entity Type | Organization
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Legal Business Name | FAMILY EAR NOSE & THROAT CLINIC PC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 6751 N 72ND ST SUITE 207
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City | OMAHA
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State | NE
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Zip | 68122-1746
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Country | US
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Telephone | 402-572-3165
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Fax | 402-572-3170
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Provider Business Mailing Address
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Address Line | 6751 N 72ND ST SUITE 207
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City | OMAHA
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State | NE
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Zip | 68122-1746
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Country | US
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Telephone | 402-572-3165
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Fax | 402-572-3170
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JILL DAMEIER
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Credential |
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Telephone | 402-572-3165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 221
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 14446
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License Number State | NE
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