Healthcare Provider Details

I. General information

NPI: 1073599189
Provider Name (Legal Business Name): CRANE RIVER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 WOODRIDGE BLVD SUITE 260
GRAND ISLAND NE
68801-7481
US

IV. Provider business mailing address

3280 WOODRIDGE BLVD SUITE 260
GRAND ISLAND NE
68801-7481
US

V. Phone/Fax

Practice location:
  • Phone: 308-389-5359
  • Fax: 308-381-4838
Mailing address:
  • Phone: 308-389-5359
  • Fax: 308-381-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number22678
License Number StateNE

VIII. Authorized Official

Name: MR. KAVIR SAXENA
Title or Position: PHSYCHIATRY
Credential: MD
Phone: 308-389-5359