Provider Demographics
NPI:1679595573
Name:NORTH PLATTE ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTH PLATTE ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINNEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-534-6655
Mailing Address - Street 1:215 MCNEEL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101
Mailing Address - Country:US
Mailing Address - Phone:308-534-6655
Mailing Address - Fax:308-534-6662
Practice Address - Street 1:215 MCNEEL LANE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0620
Practice Address - Country:US
Practice Address - Phone:308-534-6655
Practice Address - Fax:308-534-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE0351020001Medicare NSC
NE=========13Medicaid