Provider Demographics
NPI:1639101199
Name:REGIONAL WEST MEDICAL CENTER
Entity Type:Organization
Organization Name:REGIONAL WEST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ICKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1111
Mailing Address - Street 1:4021 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4602
Mailing Address - Country:US
Mailing Address - Phone:308-630-1111
Mailing Address - Fax:308-630-1815
Practice Address - Street 1:4021 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4602
Practice Address - Country:US
Practice Address - Phone:308-630-1111
Practice Address - Fax:308-630-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-05-25
Deactivation Date:2012-04-11
Deactivation Code:
Reactivation Date:2012-04-13
Provider Licenses
StateLicense IDTaxonomies
NE700001282N00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========02Medicaid
NE=========02Medicaid