1811950348 NPI number — HIGH PLAINS MEDICAL SPECIALISTS LLC

Table of content: (NPI 1811950348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811950348 NPI number — HIGH PLAINS MEDICAL SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH PLAINS MEDICAL SPECIALISTS LLC
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:
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:
1811950348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PLAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERAL
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67901-2743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-624-5691
Provider Business Mailing Address Fax Number:
620-624-3656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 AVENUE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-625-4854
Provider Business Practice Location Address Fax Number:
580-625-4854
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILHON
Authorized Official First Name:
MANDI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
620-624-5691

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100723540A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110482 . This is a "BCBS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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