Provider Demographics
NPI:1992703425
Name:REGIONAL WEST PHYSICIANS CLINIC
Entity type:Organization
Organization Name:REGIONAL WEST PHYSICIANS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO & VICE-PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1111
Mailing Address - Street 1:1456 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-1448
Mailing Address - Country:US
Mailing Address - Phone:308-623-1234
Mailing Address - Fax:308-623-1388
Practice Address - Street 1:1456 CENTER AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:NE
Practice Address - Zip Code:69357-1448
Practice Address - Country:US
Practice Address - Phone:308-623-1234
Practice Address - Fax:308-623-1388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST PHYSICIANS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-08
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECC9608OtherPALMETTO GBA
NECC9608OtherPALMETTO GBA
NE=========12Medicaid
NE283431Medicare Oscar/Certification
NE095223Medicare PIN