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General NPI Number Information
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NPI Number | 1952434417
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Entity Type | Organization
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Legal Business Name | PANHANDLE SURGICAL, P.C.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 709 W 4TH ST STE 2
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City | CHADRON
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State | NE
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Zip | 69337-2270
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Country | US
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Telephone | 308-747-2135
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Fax | 308-747-2034
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Provider Business Mailing Address
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Address Line | 709 W 4TH ST STE 2
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City | CHADRON
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State | NE
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Zip | 69337-2270
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Country | US
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Telephone | 308-747-2135
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Fax | 308-747-2034
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY D. LIAS
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Credential | M.D.
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Telephone | 308-747-2135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 19787
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License Number State | NE
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