Provider Demographics
NPI:1336552280
Name:REGIONAL WEST GARDEN COUNTY
Entity Type:Organization
Organization Name:REGIONAL WEST GARDEN COUNTY
Other - Org Name:REGIONAL WEST GARDEN COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-772-3283
Mailing Address - Street 1:1100 W 2ND ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OSHKOSH
Mailing Address - State:NE
Mailing Address - Zip Code:69154-6152
Mailing Address - Country:US
Mailing Address - Phone:308-772-3283
Mailing Address - Fax:
Practice Address - Street 1:1100 W 2ND ST
Practice Address - Street 2:STE 100
Practice Address - City:OSHKOSH
Practice Address - State:NE
Practice Address - Zip Code:69154-6152
Practice Address - Country:US
Practice Address - Phone:308-772-3283
Practice Address - Fax:308-772-3284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST GARDEN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE283440Medicare Oscar/Certification
NENA1929Medicare PIN