Provider Demographics
NPI:1801115811
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:BOARD OF MANAGERS
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 1:601 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6598
Mailing Address - Country:US
Mailing Address - Phone:308-696-8344
Mailing Address - Fax:308-696-8349
Practice Address - Street 1:215 MCNEEL LN
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6054
Practice Address - Country:US
Practice Address - Phone:308-534-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH PLATTE NEBRASKA PHYSICIAN GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-01
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDQ4296Medicare PIN
NENA1628Medicare PIN