Basic Information
| Provider Information | |||||||||
| NPI: | 1316934029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVOTNY | ||||||||
| FirstName: | NILA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4508 38TH ST | ||||||||
| Address2: | SUITE #152 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686011668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025634500 | ||||||||
| FaxNumber: | 4025633520 | ||||||||
| Practice Location | |||||||||
| Address1: | 4508 38TH ST | ||||||||
| Address2: | SUITE #152 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686011668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025634500 | ||||||||
| FaxNumber: | 4025633520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 17352 | NE | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1538141593 | 05 | NE | MEDICAID | 040007717 | 01 | NE | RAILROAD MEDICARE # | OTHER | 3891 | 01 | NE | MIDLANDS CHOICE PPO | OTHER | 061181648-68601-A002 | 01 | NE | TRIWEST | OTHER | 10025979300 | 05 | NE | MEDICAID | 04465 | 01 | NE | BLUE CROSS OF NEBRASKA | OTHER | 06118164800 | 05 | NE | MEDICAID |