Basic Information
| Provider Information | |||||||||
| NPI: | 1528796356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INPATIENT PHYSICIAN ASSOCIATES GRAND ISLAND LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6971 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685060971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024867040 | ||||||||
| FaxNumber: | 4024346047 | ||||||||
| Practice Location | |||||||||
| Address1: | 3533 PRAIRIEVIEW ST | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688034409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024818566 | ||||||||
| FaxNumber: | 4024818805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2022 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | CLOUGH | ||||||||
| AuthorizedOfficialFirstName: | ALISSA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4024818566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.