Provider Demographics
NPI:1518208024
Name:GREAT PLAINS DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:GREAT PLAINS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-391-2005
Mailing Address - Street 1:825 N 90TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2702
Mailing Address - Country:US
Mailing Address - Phone:402-391-2005
Mailing Address - Fax:402-408-1783
Practice Address - Street 1:825 N 90TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2702
Practice Address - Country:US
Practice Address - Phone:402-391-2005
Practice Address - Fax:402-408-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
28D2054456OtherCLIA