Provider Demographics
NPI:1831507409
Name:TWIN RIVERS URGENT CARE LLC
Entity type:Organization
Organization Name:TWIN RIVERS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOKELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-534-2900
Mailing Address - Street 1:720 N WEBB
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-6293
Mailing Address - Country:US
Mailing Address - Phone:308-384-2500
Mailing Address - Fax:
Practice Address - Street 1:220 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6293
Practice Address - Country:US
Practice Address - Phone:308-534-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care