1790866762 NPI number — PANHANDLE HEALTH SERVICE

Table of content: (NPI 1790866762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790866762 NPI number — PANHANDLE HEALTH SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANHANDLE HEALTH SERVICE
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:
1790866762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 W 42ND ST
Provider Second Line Business Mailing Address:
SUITE 3200
Provider Business Mailing Address City Name:
SCOTTSBLUFF
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69361-4669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-630-1115
Provider Business Mailing Address Fax Number:
308-630-1817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 W 42ND ST
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361-4669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-630-1115
Provider Business Practice Location Address Fax Number:
308-630-1817
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COPPLE
Authorized Official First Name:
CURT
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
308-630-1115

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 098511 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CC9608 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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