Basic Information
Provider Information | |||||||||
NPI: | 1730108739 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KROBOT | ||||||||
FirstName: | SCOTT | ||||||||
MiddleName: | PATRICK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8005 FARNAM DR | ||||||||
Address2: | STE 305 | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681143426 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4023904111 | ||||||||
FaxNumber: | 4023998455 | ||||||||
Practice Location | |||||||||
Address1: | 17030 LAKESIDE HILLS PLZ | ||||||||
Address2: | SUITE 200 | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 68130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4023998550 | ||||||||
FaxNumber: | 4023998455 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2006 | ||||||||
LastUpdateDate: | 04/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1240 | NE | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 1144277328 | 05 | IA |   | MEDICAID | 1144277328 | 05 | NE |   | MEDICAID | P00341614 | 01 |   | RAILROAD MEDICARE | OTHER | 38518 | 01 | NE | BCBS | OTHER |