Provider Demographics
NPI:1740524354
Name:NORTH PLATTE NEBRASKA PHYSICIAN GROUP LLC
Entity type:Organization
Organization Name:NORTH PLATTE NEBRASKA PHYSICIAN GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-696-7496
Mailing Address - Street 1:516 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6533
Mailing Address - Country:US
Mailing Address - Phone:308-534-5370
Mailing Address - Fax:308-534-3813
Practice Address - Street 1:516 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6533
Practice Address - Country:US
Practice Address - Phone:308-534-5370
Practice Address - Fax:308-534-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty