Provider Demographics
NPI:1386803997
Name:CENTRAL PLAINS PLASTIC & RECONSTRUCTIVE SURGERY PC
Entity type:Organization
Organization Name:CENTRAL PLAINS PLASTIC & RECONSTRUCTIVE SURGERY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ATCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-865-2737
Mailing Address - Street 1:3712 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1258
Mailing Address - Country:US
Mailing Address - Phone:308-865-2737
Mailing Address - Fax:308-865-6098
Practice Address - Street 1:3712 28TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1258
Practice Address - Country:US
Practice Address - Phone:308-865-2737
Practice Address - Fax:308-865-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC055261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical