Provider Demographics
NPI:1336221936
Name:ADVANCED ENT
Entity Type:Organization
Organization Name:ADVANCED ENT
Other - Org Name:MARK FREY MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGILIO-WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-621-6486
Mailing Address - Street 1:401 E GOLD COAST RD STE 331
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4194
Mailing Address - Country:US
Mailing Address - Phone:402-292-9800
Mailing Address - Fax:402-292-2550
Practice Address - Street 1:401 E GOLD COAST RD STE 331
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4194
Practice Address - Country:US
Practice Address - Phone:402-292-9800
Practice Address - Fax:402-292-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336116797OtherNPI
IA0588731Medicaid
NE10025184900Medicaid
IA0588731Medicaid
D50935Medicare UPIN
1336116797OtherNPI
NE10025184900Medicaid