1295155745 NPI number — REGIONAL WEST MEDICAL CENTER

Table of content: (NPI 1295155745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295155745 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:
Provider Other Organization Name Type Code:
6
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:
1295155745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2016
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:
3701 AVENUE D
Provider Second Line Business Practice Location Address:
SUITE 2204
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361-4771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-630-1149
Provider Business Practice Location Address Fax Number:
308-630-1886
Provider Enumeration Date:
04/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ICKOWSKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
VICE PRESIDENT / CFO
Authorized Official Telephone Number:
308-630-1111

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HOSPICE 56 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025140000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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