Provider Demographics
NPI:1851894810
Name:GREAT PLAINS TELEHEALTH
Entity Type:Organization
Organization Name:GREAT PLAINS TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:RALL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:901-626-4419
Mailing Address - Street 1:PO BOX 2226
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716
Mailing Address - Country:US
Mailing Address - Phone:800-787-1704
Mailing Address - Fax:
Practice Address - Street 1:3901 S COLLEGE PARK CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-9441
Practice Address - Country:US
Practice Address - Phone:800-787-1704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care