Provider Demographics
NPI:1821044223
Name:GREAT PLAINS MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:GREAT PLAINS MEDICAL SUPPLY INC
Other - Org Name:GREAT PLAINS HOMECARE EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-534-1873
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1596
Mailing Address - Country:US
Mailing Address - Phone:308-534-1873
Mailing Address - Fax:308-534-1866
Practice Address - Street 1:600 E FRANCIS ST
Practice Address - Street 2:SUITE 6
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6796
Practice Address - Country:US
Practice Address - Phone:308-534-1873
Practice Address - Fax:308-534-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE131332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid