Provider Demographics
NPI:1619034253
Name:HIGH PLAINS MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:HIGH PLAINS MEDICAL FOUNDATION
Other - Org Name:CAMS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNET/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-254-5544
Mailing Address - Street 1:1625 DORWART DR
Mailing Address - Street 2:PO BOX 379
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2505
Mailing Address - Country:US
Mailing Address - Phone:308-254-5544
Mailing Address - Fax:308-254-2672
Practice Address - Street 1:562 VINCENT AVE.
Practice Address - Street 2:
Practice Address - City:CHAPPELL
Practice Address - State:NE
Practice Address - Zip Code:69129
Practice Address - Country:US
Practice Address - Phone:308-874-2255
Practice Address - Fax:308-874-2854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN NEBRASKA HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QP2300X
NE283861261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025499800Medicaid
NECN7427OtherRR MEDICARE
NE10025511600Medicaid
NE1945OtherBCBS
NECN7427OtherRR MEDICARE
NE10025511600Medicaid