Provider Demographics
NPI:1740333608
Name:MIDWEST ORTHOPEDICS PC
Entity type:Organization
Organization Name:MIDWEST ORTHOPEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-2663
Mailing Address - Street 1:6829 N 72 ST
Mailing Address - Street 2:SUITE 7500
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1790
Mailing Address - Country:US
Mailing Address - Phone:402-572-2663
Mailing Address - Fax:402-572-2671
Practice Address - Street 1:6829 N 72 ST
Practice Address - Street 2:SUITE 7500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1790
Practice Address - Country:US
Practice Address - Phone:402-572-2663
Practice Address - Fax:402-572-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS877620OtherRAILROAD MEDICARE
NE=========13Medicaid
NE086167Medicare PIN
NE0497920001Medicare NSC
NE=========13Medicaid