Provider Demographics
NPI:1013187624
Name:CENTRAL PLAINS PLASTIC & RECONSTRUCTIVE SURGERY, PC
Entity Type:Organization
Organization Name:CENTRAL PLAINS PLASTIC & RECONSTRUCTIVE SURGERY, PC
Other - Org Name:CENTRAL PLAINS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ATCHSION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-865-2737
Mailing Address - Street 1:3712 28TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845
Mailing Address - Country:US
Mailing Address - Phone:308-865-2737
Mailing Address - Fax:
Practice Address - Street 1:3712 28TH AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-865-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20766208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00333OtherBCBS
NE=========00Medicaid
NE00333OtherBCBS