Provider Demographics
NPI:1841378379
Name:FITZPATRICK EAR, NOSE & THROAT CLINIC, P.C.
Entity type:Organization
Organization Name:FITZPATRICK EAR, NOSE & THROAT CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:308-532-3330
Mailing Address - Street 1:801 WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6556
Mailing Address - Country:US
Mailing Address - Phone:308-532-3330
Mailing Address - Fax:308-532-3334
Practice Address - Street 1:801 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6556
Practice Address - Country:US
Practice Address - Phone:308-532-3330
Practice Address - Fax:308-532-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid
099047Medicare ID - Type Unspecified