Provider Demographics
NPI:1851507933
Name:BROADHEAD, SARAH KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KATHRYN
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:717 N 190TH PLZ
Practice Address - Street 2:STE. 3100
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3913
Practice Address - Country:US
Practice Address - Phone:402-815-1325
Practice Address - Fax:402-815-2020
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731742Medicaid
NE10026480100Medicaid
IA1851507933Medicaid
NE10025837400Medicaid
NE0990992221Medicare PIN