Provider Demographics
NPI:1710087036
Name:KEARNEY UROLOGY CENTER P.C.
Entity Type:Organization
Organization Name:KEARNEY UROLOGY CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-237-7719
Mailing Address - Street 1:123 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2916
Mailing Address - Country:US
Mailing Address - Phone:308-237-7719
Mailing Address - Fax:308-236-6975
Practice Address - Street 1:123 W 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2916
Practice Address - Country:US
Practice Address - Phone:308-237-7719
Practice Address - Fax:308-236-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100356430AMedicaid
NE6266OtherS.F. HOWE-MIDLANDS ID
NE01500OtherLAROY WILLIAMS-BCBS ID
NE30621OtherDR. S.F. HOWE-BCBS ID
NE6267OtherE.K. LARSON-MIDLANDS ID
KS100120100AMedicaid
NE13026OtherL.E. WILLIAMS-MIDLANDS ID
NE1671OtherDR. E.K. LARSON-BCBS ID
KS100356430AMedicaid
NE6266OtherS.F. HOWE-MIDLANDS ID
NE6267OtherE.K. LARSON-MIDLANDS ID
NE1671OtherDR. E.K. LARSON-BCBS ID
NE098374Medicare ID - Type UnspecifiedKEARNEY UROLOGY CENTER
KS100356430AMedicaid