Organization
MINNECHADUZA MEDICAL CLINIC P.C.
Active
Other names
Minnechaduza Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY W RYSCHON M.D. (OWNER/MEDICAL DIRECTOR)
(402) 389-2121
Entity
Organization
Contact information
Practice address
148 E 1ST ST, SUITE 400, VALENTINE, NE 69201-1802
(402) 376-1368
(866) 614-6108
Mailing address
148 E 1ST ST, SUITE 400, VALENTINE, NE 69201-1802
(402) 376-1368
(866) 614-6108
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20604
NE
208000000X
Pediatrics Physician
4298
SD
208000000X
Pediatrics Physician
43417
CO
363A00000X
Physician Assistant
536
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00866
BCBS NEBRASKA
NE
05
—
10025277700
—
NE
05
—
7714810
—
SD
Enumeration date
06/29/2009
Last updated
06/29/2009
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