Provider Demographics
NPI:1134642341
Name:GREAT PLAINS PHO
Entity Type:Organization
Organization Name:GREAT PLAINS PHO
Other - Org Name:GREAT PLAINS HEALTH INNOVATION NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OF CLINICAL INTEGRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-568-7197
Mailing Address - Street 1:601 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6598
Mailing Address - Country:US
Mailing Address - Phone:308-568-7496
Mailing Address - Fax:308-535-3410
Practice Address - Street 1:601 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6525
Practice Address - Country:US
Practice Address - Phone:308-568-7496
Practice Address - Fax:308-535-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization