Provider Demographics
NPI:1871793158
Name:KEARNEY ARTHRITIS INSTITUTE PC
Entity type:Organization
Organization Name:KEARNEY ARTHRITIS INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-234-9615
Mailing Address - Street 1:109 E 52ND ST
Mailing Address - Street 2:STUITE 2
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-0502
Mailing Address - Country:US
Mailing Address - Phone:308-234-9615
Mailing Address - Fax:308-234-9614
Practice Address - Street 1:22 W 56TH ST STE 107
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-0508
Practice Address - Country:US
Practice Address - Phone:308-234-9615
Practice Address - Fax:308-234-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19423207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253310-00Medicaid
E89758Medicare UPIN
NE100253310-00Medicaid