Provider Demographics
NPI:1275603995
Name:CHESTER H WATERS III MD PC
Entity Type:Organization
Organization Name:CHESTER H WATERS III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:402-492-9922
Mailing Address - Street 1:11819 MIRACLE HILLS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4428
Mailing Address - Country:US
Mailing Address - Phone:402-492-9922
Mailing Address - Fax:402-492-9944
Practice Address - Street 1:11819 MIRACLE HILLS DR STE 203
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4428
Practice Address - Country:US
Practice Address - Phone:402-492-9922
Practice Address - Fax:402-492-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1599OtherBCBS NE
NE=========00Medicaid
NE0155240001Medicare NSC