Provider Demographics
NPI:1245391119
Name:CENTRAL PLAINS ENT, PC
Entity Type:Organization
Organization Name:CENTRAL PLAINS ENT, PC
Other - Org Name:CENTRAL PLAINS ENT & AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-502-6970
Mailing Address - Street 1:8005 FARNAM DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3426
Mailing Address - Country:US
Mailing Address - Phone:402-502-6970
Mailing Address - Fax:402-502-6930
Practice Address - Street 1:8005 FARNAM DR
Practice Address - Street 2:SUITE 204
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3426
Practice Address - Country:US
Practice Address - Phone:402-502-6970
Practice Address - Fax:402-502-6930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6520013Medicaid
ND11798Medicaid
IA0561399Medicaid
ND11798Medicaid
SDS41554Medicare PIN
NE099241Medicare PIN
NE=========00Medicaid