Provider Demographics
NPI:1710033121
Name:REGIONAL WEST MEDICAL CENTER
Entity Type:Organization
Organization Name:REGIONAL WEST MEDICAL CENTER
Other - Org Name:COMMUNITY PHARMACY AT REGIONAL WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO VICEPRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1111
Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE M-200
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-630-1900
Mailing Address - Fax:308-630-1969
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE M-200
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-1900
Practice Address - Fax:308-630-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENABP#2815439OtherNAPB#
NE2384OtherSTATE LICENSE #
NENABP#2815439OtherNAPB#
NE=========50Medicaid