Provider Demographics
NPI:1841737418
Name:KEARNEY CLINIC PC
Entity Type:Organization
Organization Name:KEARNEY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DOBISH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:308-865-2141
Mailing Address - Street 1:211 W 33 ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3456
Mailing Address - Country:US
Mailing Address - Phone:308-865-2141
Mailing Address - Fax:308-234-7582
Practice Address - Street 1:211 W 33 ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3456
Practice Address - Country:US
Practice Address - Phone:308-865-2141
Practice Address - Fax:308-234-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
097467OtherMEDICARE