Provider Demographics
NPI:1144203324
Name:PLATTE VALLEY MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:PLATTE VALLEY MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-865-2263
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0550
Mailing Address - Country:US
Mailing Address - Phone:308-865-2808
Mailing Address - Fax:308-865-2541
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-865-2263
Practice Address - Fax:308-865-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4751790001Medicare NSC
NE095577Medicare ID - Type Unspecified