Provider Demographics
NPI:1841486479
Name:GRAND ISLAND EAR, NOSE & THROAT PC
Entity type:Organization
Organization Name:GRAND ISLAND EAR, NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:NABITY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-384-5700
Mailing Address - Street 1:704 N ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4318
Mailing Address - Country:US
Mailing Address - Phone:308-384-5700
Mailing Address - Fax:308-384-4305
Practice Address - Street 1:704 N ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4318
Practice Address - Country:US
Practice Address - Phone:308-384-5700
Practice Address - Fax:308-384-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid