Provider Demographics
NPI:1588777817
Name:REGIONAL WEST MEDICAL CENTER
Entity type:Organization
Organization Name:REGIONAL WEST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ICKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1111
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-1437
Mailing Address - Country:US
Mailing Address - Phone:308-630-1430
Mailing Address - Fax:308-630-1823
Practice Address - Street 1:3701 AVENUE D
Practice Address - Street 2:SUITE 2105
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4771
Practice Address - Country:US
Practice Address - Phone:308-630-1430
Practice Address - Fax:308-630-1823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE701002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-03Medicaid
NE=========-03Medicaid