Provider Demographics
NPI:1972793925
Name:NEBRASKA NEUROSURGERY & SPINE CLINIC P C
Entity Type:Organization
Organization Name:NEBRASKA NEUROSURGERY & SPINE CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BADEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:308-234-9822
Mailing Address - Street 1:3219 CENTRAL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2949
Mailing Address - Country:US
Mailing Address - Phone:308-234-9822
Mailing Address - Fax:308-234-9824
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-234-9822
Practice Address - Fax:308-234-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19006207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102023OtherBCBS KS
KS100143550BMedicaid
KS100143550CMedicaid
KS100143550CMedicaid
F53479Medicare UPIN