Provider Demographics
NPI:1538141593
Name:NILA MOORE NOVOTNY
Entity Type:Organization
Organization Name:NILA MOORE NOVOTNY
Other - Org Name:COLUMBUS OTOLARYNGOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:NILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOVOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-563-4500
Mailing Address - Street 1:4508 38TH ST
Mailing Address - Street 2:STE 152
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-563-4500
Mailing Address - Fax:402-563-3520
Practice Address - Street 1:4508 38TH ST
Practice Address - Street 2:SUITE #152
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1668
Practice Address - Country:US
Practice Address - Phone:402-563-4500
Practice Address - Fax:402-563-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17352207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1538141593OtherTRIWEST
NE01923OtherBLUE CROSS GROUP #
NE10025979300Medicaid