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General NPI Number Information
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NPI Number | 1659909117
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Entity Type | Organization
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Legal Business Name | SPAN PSYCHIATRY SERVICES PC
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 914 BAUMANN DR
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4401
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Country | US
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Telephone | 308-395-1035
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Fax |
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Provider Business Mailing Address
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Address Line | 224 PONDEROSA DR
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City | GRAND ISLAND
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State | NE
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Zip | 68803-9647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAVDEEP SOOD
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Credential |
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Telephone | 308-395-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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