Provider Demographics
NPI:1538163092
Name:CENTRAL NEBRASKA ORTHOPEDICS & SPORTS MEDICINE, P.C.
Entity type:Organization
Organization Name:CENTRAL NEBRASKA ORTHOPEDICS & SPORTS MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAHOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-384-5400
Mailing Address - Street 1:620 N DIERS AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4984
Mailing Address - Country:US
Mailing Address - Phone:308-384-5400
Mailing Address - Fax:308-384-5201
Practice Address - Street 1:620 N DIERS AVE
Practice Address - Street 2:STE 200
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4984
Practice Address - Country:US
Practice Address - Phone:308-384-5400
Practice Address - Fax:308-384-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-11
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15386207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1808OtherBC/BS
NE100423100BMedicaid
KS2487600101Medicaid
KS2287561201Medicaid
KS200305850AMedicaid
KS2087327101Medicaid
NE=========12Medicaid
KS2287561201Medicaid
NE1808OtherBC/BS