Provider Demographics
NPI:1609843580
Name:MIDLANDS PEDIATRICS PC
Entity Type:Organization
Organization Name:MIDLANDS PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AI LAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-592-1700
Mailing Address - Street 1:401 E GOLD COAST RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4194
Mailing Address - Country:US
Mailing Address - Phone:402-592-1700
Mailing Address - Fax:402-592-3335
Practice Address - Street 1:401 E GOLD COAST RD
Practice Address - Street 2:SUITE 325
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4194
Practice Address - Country:US
Practice Address - Phone:402-592-1700
Practice Address - Fax:402-592-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
F68209Medicare UPIN