Organization
ENT SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEIGH JEAN KOINZAN (CORPORATE SECRETARY)
(402) 498-6617
Entity
Organization
Contact information
Practice address
555 N 30TH ST, OMAHA, NE 68131-2136
(402) 498-6509
(402) 498-6357
Mailing address
555 N 30TH ST, OMAHA, NE 68131-2136
(402) 498-6509
(402) 498-6357
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
225100000X
Physical Therapist
—
—
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02911
BCBS OF NE GROUP #
NE
05
—
10025002700
—
NE
05
—
10025004100
—
NE
05
—
10025027000
—
NE
05
—
10025089100
—
NE
05
—
10025146400
—
NE
05
—
10025170900
—
NE
05
—
10025298800
—
NE
Enumeration date
09/20/2006
Last updated
10/14/2011
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