Provider Demographics
NPI:1952414526
Name:PANHANDLE HEALTH SERVICES
Entity Type:Organization
Organization Name:PANHANDLE HEALTH SERVICES
Other - Org Name:WESTERN PLAINS NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KISHIYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1947
Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 2550
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4669
Mailing Address - Country:US
Mailing Address - Phone:308-630-1947
Mailing Address - Fax:308-630-1439
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 2550
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4669
Practice Address - Country:US
Practice Address - Phone:308-630-1947
Practice Address - Fax:308-630-1439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-016OtherTRICARE/CHAMPUS GROUP NO
NE=========-016OtherTRICARE/CHAMPUS GROUP NO