Provider Demographics
NPI:1114065216
Name:PANHANDLE HEALTH SERVICES
Entity Type:Organization
Organization Name:PANHANDLE HEALTH SERVICES
Other - Org Name:WESTERN REGIONAL ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1115
Mailing Address - Street 1:3911 AVENUE B STE 3400
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-635-8900
Mailing Address - Fax:308-635-8920
Practice Address - Street 1:3911 AVENUE B STE 3400
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-635-8900
Practice Address - Fax:308-635-8920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE22469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025280400Medicaid
CC9608OtherRR MEDICARE GROUP NUMBER
099051OtherMEDICARE GROUP NUMBER