Provider Demographics
NPI:1386187375
Name:NORTH PLATTE NEBRASKA PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:NORTH PLATTE NEBRASKA PHYSICIAN GROUP LLC
Other - Org Name:GREAT PLAINS NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD OF MANAGERS
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:308-568-7496
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:308-568-8356
Mailing Address - Fax:308-568-8349
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:STE 270
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0614
Practice Address - Country:US
Practice Address - Phone:308-532-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty