1578571329 NPI number — COMMUNITY MEMORIAL HOSPITAL DISTRICT

Table of content: (NPI 1578571329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578571329 NPI number — COMMUNITY MEMORIAL HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MEMORIAL HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578571329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68446-0518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-269-2011
Provider Business Mailing Address Fax Number:
402-269-7621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1579 MIDLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68446-9732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-269-2011
Provider Business Practice Location Address Fax Number:
402-269-7621
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-269-2011

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  581003 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 230 . This is a "BCBS OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".