Provider Demographics
NPI:1245241249
Name:PANHANDLE HEALTH SERVICES
Entity Type:Organization
Organization Name:PANHANDLE HEALTH SERVICES
Other - Org Name:REGIONAL NEUROLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KISHIYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1947
Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-630-2030
Mailing Address - Fax:308-630-2060
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 2300
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-2030
Practice Address - Fax:308-630-2060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECC9608OtherRAILROAD MEDICARE
NE099051Medicare ID - Type UnspecifiedGROUP