Provider Demographics
NPI:1700173861
Name:REGIONAL WEST GARDEN COUNTY
Entity Type:Organization
Organization Name:REGIONAL WEST GARDEN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1111
Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0617
Mailing Address - Country:US
Mailing Address - Phone:308-630-1149
Mailing Address - Fax:308-630-1886
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0617
Practice Address - Country:US
Practice Address - Phone:308-630-1149
Practice Address - Fax:308-630-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE701500OtherNEBRASKA LICENSE
NE281506Medicare Oscar/Certification