1588771158 NPI number — COMMUNITY HOSPITAL ASSOCIATION

Table of content: (NPI 1588771158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588771158 NPI number — COMMUNITY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HOSPITAL ASSOCIATION
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 HOSPITAL PROFESSIONAL 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:
1588771158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCCOOK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69001-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-344-2650
Provider Business Mailing Address Fax Number:
308-344-8358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 E H ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC COOK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69001-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-344-2650
Provider Business Practice Location Address Fax Number:
308-344-8358
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNTZ
Authorized Official First Name:
TROY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
308-344-8315

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 03615 . This is a "BLUE CROSS RHC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 81042 . This is a "BLUE CROSS DIABETIC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 03424 . This is a "BLUE CROSS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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