Provider Demographics
NPI:1518270883
Name:NEOSOM CLINICS DBA ENT & SLEEP MEDICINE
Entity Type:Organization
Organization Name:NEOSOM CLINICS DBA ENT & SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KIMBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-465-0123
Mailing Address - Street 1:700 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9013
Mailing Address - Country:US
Mailing Address - Phone:316-283-2828
Mailing Address - Fax:316-283-2830
Practice Address - Street 1:7261 OHMS LN
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2148
Practice Address - Country:US
Practice Address - Phone:612-465-0123
Practice Address - Fax:952-843-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32263207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200577150AMedicaid