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General NPI Number Information
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NPI Number | 1285862359
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Entity Type | Organization
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Legal Business Name | MINNECHADUZA MEDICAL CLINIC P.C.
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 148 E 1ST ST SUITE 400
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City | VALENTINE
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State | NE
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Zip | 69201-1802
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Country | US
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Telephone | 402-376-1368
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Fax | 866-614-6108
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Provider Business Mailing Address
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Address Line | 148 E 1ST ST SUITE 400
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City | VALENTINE
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State | NE
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Zip | 69201-1802
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Country | US
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Telephone | 402-376-1368
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Fax | 866-614-6108
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. TIMOTHY W RYSCHON
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Credential | M.D.
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Telephone | 402-389-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4298
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 43417
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 536
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20604
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License Number State | NE
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