Provider Demographics
NPI:1326376476
Name:EAR, NOSE AND THROAT ASSOCIATES P.C.
Entity Type:Organization
Organization Name:EAR, NOSE AND THROAT ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-393-8910
Mailing Address - Street 1:8601 W DODGE RD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3457
Mailing Address - Country:US
Mailing Address - Phone:402-393-8910
Mailing Address - Fax:402-393-3350
Practice Address - Street 1:8601 W DODGE RD
Practice Address - Street 2:SUITE 234
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3457
Practice Address - Country:US
Practice Address - Phone:402-393-8910
Practice Address - Fax:402-393-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10836207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE093301Medicare PIN