Basic Information
| Provider Information | |||||||||
| NPI: | 1386187375 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH PLATTE NEBRASKA PHYSICIAN GROUP LLC | ||||||||
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| OtherOrganizationName: | GREAT PLAINS NEPHROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W LEOTA ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691016598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085688356 | ||||||||
| FaxNumber: | 3085688349 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 W FRANCIS ST | ||||||||
| Address2: | STE 270 | ||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691010614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085323022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2016 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLAYMORE | ||||||||
| AuthorizedOfficialFirstName: | KRYSTAL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | BOARD OF MANAGERS | ||||||||
| AuthorizedOfficialTelephone: | 3085687496 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.