Provider Demographics
NPI:1871673384
Name:EAR, NOSE & THROAT SPECIALTIES, P.C.
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT SPECIALTIES, P.C.
Other - Org Name:ENT SPECIALTIES, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSCIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CEDERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-488-5600
Mailing Address - Street 1:5055 A ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4970
Mailing Address - Country:US
Mailing Address - Phone:402-488-5600
Mailing Address - Fax:402-488-7649
Practice Address - Street 1:5055 A ST STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4970
Practice Address - Country:US
Practice Address - Phone:402-488-5600
Practice Address - Fax:402-488-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-09-01
Deactivation Date:2023-07-25
Deactivation Code:
Reactivation Date:2023-09-01
Provider Licenses
StateLicense IDTaxonomies
NE207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE092620Medicare PIN