Healthcare Provider Details

I. General information

NPI: 1518208024
Provider Name (Legal Business Name): GREAT PLAINS DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N 90TH ST SUITE 500
OMAHA NE
68114-2702
US

IV. Provider business mailing address

825 N 90TH ST SUITE 500
OMAHA NE
68114-2702
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-2005
  • Fax: 402-408-1783
Mailing address:
  • Phone: 402-391-2005
  • Fax: 402-408-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SCOTT BOYD
Title or Position: OWNER
Credential: MD
Phone: 402-391-2005