Provider Demographics
NPI:1003151036
Name:PLAZA WEST PSYCHIATRISTS
Entity Type:Organization
Organization Name:PLAZA WEST PSYCHIATRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:NADALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-474-1511
Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3796
Mailing Address - Country:US
Mailing Address - Phone:402-474-1511
Mailing Address - Fax:402-474-1611
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-474-1511
Practice Address - Fax:402-474-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health