1053613810 NPI number — REGIONAL WEST MEDICAL CENTER

Table of content: (NPI 1053613810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053613810 NPI number — REGIONAL WEST MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL WEST MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REGIONAL WEST LABORATORY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053613810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4021 AVENUE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBLUFF
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69361-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-630-1111
Provider Business Mailing Address Fax Number:
308-630-1815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1174 N 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82072-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-745-8022
Provider Business Practice Location Address Fax Number:
307-745-8287
Provider Enumeration Date:
11/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFITHS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
CFO/VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
308-630-1111

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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