Provider Demographics
NPI:1831154236
Name:NEOSOM CLINICS, P.A.
Entity type:Organization
Organization Name:NEOSOM CLINICS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIMBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-465-0123
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-7808
Mailing Address - Country:US
Mailing Address - Phone:316-283-2828
Mailing Address - Fax:316-283-2830
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-7808
Practice Address - Country:US
Practice Address - Phone:316-283-2828
Practice Address - Fax:316-283-2830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOSOM CLINICS, P.A. DBA ENT & SLEEP ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03917Medicare ID - Type Unspecified