# SCOTTSBLUFF UROLOGY ASSOC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780615401
- **Authorized official:** DR. JOHN N. KABALIN M.D. (PRESIDENT)
- **Authorized official phone:** (308) 632-5315

## Contact information

- **Practice address:** 3911 AVENUE B, 2200, SCOTTSBLUFF, NE 69361-4617
- **Practice address phone:** (308) 632-5315
- **Practice address fax:** (308) 632-5261
- **Mailing address:** 3911 AVENUE B, 2200, SCOTTSBLUFF, NE 69361-4617
- **Mailing address phone:** (308) 632-5315
- **Mailing address fax:** (308) 632-5261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 10/07/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102713100 | — | WY |