ENT SERVICES PC

Provider Demographics

• NPI: 1194822130
• Name: ENT SERVICES PC
• Entity Type: Organization
• Organization Name: ENT SERVICES PC
• Authorized Official - Title/Position: CORPORATE SECRETARY
• Authorized Official - Prefix: MS
• Authorized Official - First Name: LEIGH
• Authorized Official - Middle Name: JEAN
• Authorized Official - Last Name: KOINZAN
• Authorized Official - Phone: 402-498-6617
• Mailing Address - Street 1: 555 N 30TH ST
• Mailing Address - City: OMAHA
• Mailing Address - State: NE
• Mailing Address - Zip Code: 68131-2136
• Mailing Address - Country: US
• Mailing Address - Phone: 402-498-6509
• Mailing Address - Fax: 402-498-6357
• Practice Address - Street 1: 555 N 30TH ST
• Practice Address - City: OMAHA
• Practice Address - State: NE
• Practice Address - Zip Code: 68131-2136
• Practice Address - Country: US
• Practice Address - Phone: 402-498-6509
• Practice Address - Fax: 402-498-6357
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-09-20
• Last Update Date: 2011-10-14

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Multi-Specialty
No	207KA0200X	Allopathic & Osteopathic Physicians	Allergy & Immunology	Allergy	Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	02911	Other	BCBS OF NE GROUP #
NE	10025146400	Medicaid
NE	10025089100	Medicaid
NE	10025298800	Medicaid
NE	10025002700	Medicaid
NE	10025004100	Medicaid
NE	10025170900	Medicaid
NE	10025027000	Medicaid
NE	=========05	Medicaid
NE	10025089100	Medicaid
NE	10025298800	Medicaid
NE	=========66	Medicaid
NE	=========04	Medicaid
NE	=========06	Medicaid
NE	=========12	Medicaid
NE	02911	Other	BCBS OF NE GROUP #
NE	=========00	Medicaid
NE	=========68	Medicaid
NE	10025004100	Medicaid
NE	=========06	Medicaid
NE	086090	Medicare PIN