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General NPI Number Information
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NPI Number | 1386803997
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Entity Type | Organization
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Legal Business Name | CENTRAL PLAINS PLASTIC & RECONSTRUCTIVE SURGERY PC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 3712 28TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-1258
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Country | US
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Telephone | 308-865-2737
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Fax | 308-865-6098
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Provider Business Mailing Address
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Address Line | 3712 28TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-1258
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Country | US
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Telephone | 308-865-2737
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Fax | 308-865-6098
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL R. ATCHISON
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Credential | MD
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Telephone | 308-865-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASC055
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License Number State | NE
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