Provider Demographics
NPI:1629220991
Name:GREAT PLAINS GERIATRICS, LLC
Entity Type:Organization
Organization Name:GREAT PLAINS GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-733-3448
Mailing Address - Street 1:13927 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4044
Mailing Address - Country:US
Mailing Address - Phone:402-733-3448
Mailing Address - Fax:
Practice Address - Street 1:13927 MONROE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-4044
Practice Address - Country:US
Practice Address - Phone:402-733-3448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ-113706251J00000X
NE110846251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care