Minnechaduza Medical Clinic P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

20604 Issued in NE

Legal business name

MINNECHADUZA MEDICAL CLINIC P.C.

Practice address

148 E 1St St
Suite 400
Valentine, NE 69201-1802

Phone

(402) 376-1368

Fax

(866) 614-6108

NPI assigned

Jun 29, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy W Ryschon, M.D.

Title

Owner/Medical Director

Phone

(402) 389-2121

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Minnechaduza Medicine Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246233600000",
    "number": "1285862359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 E 1ST ST",
            "address_2": "SUITE 400",
            "city": "VALENTINE",
            "state": "NE",
            "postal_code": "692011802",
            "telephone_number": "402-376-1368",
            "fax_number": "866-614-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 E 1ST ST",
            "address_2": "SUITE 400",
            "city": "VALENTINE",
            "state": "NE",
            "postal_code": "692011802",
            "telephone_number": "402-376-1368",
            "fax_number": "866-614-6108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNECHADUZA MEDICAL CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-06-29",
        "status": "A",
        "authorized_official_last_name": "RYSCHON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "402-389-2121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "20604",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "SD",
            "license": "4298",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "43417",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "536",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NEBRASKA",
            "identifier": "00866",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7714810",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025277700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnechaduza Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sara Jo Mayhew, RN
• Nicole McCarthy, PTA
• Chester J. McCormick, O.D.
• Lois Ellen McLeod
• Jared L Michalson, M.D.
• Carolyn Moore
• Michele Nicole Mulligan-Witt, MD
• Northland Hearing Centers, Inc. (White's Advanced Hearing)
• Robert Oliver
• Lynette Olson, APRN-FNP

• Pediatrics Physician in Valentine, NE
• Providers in Valentine, NE by specialty
• Pediatrics Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.