Provider Demographics
NPI:1710097654
Name:CONSULTANTS IN EAR NOSE AND THROAT PC
Entity Type:Organization
Organization Name:CONSULTANTS IN EAR NOSE AND THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-552-2955
Mailing Address - Street 1:4242 FARNAM ST
Mailing Address - Street 2:#265
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-2955
Mailing Address - Fax:402-552-3183
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:#265
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-2955
Practice Address - Fax:402-552-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099889Medicare ID - Type UnspecifiedGROUP #