1033203567 NPI number — GORDON MEMORIAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033203567 NPI number — GORDON MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDON MEMORIAL HOSPITAL
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:
Provider Other Organization Name Type Code:
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:
1033203567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 750
Provider Second Line Business Mailing Address:
307 CONRAD STREET
Provider Business Mailing Address City Name:
RUSHVILLE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69360-0750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-327-2757
Provider Business Mailing Address Fax Number:
308-327-2070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 CONRAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSHVILLE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69360-0750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-327-2757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
308-282-0401

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  730001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 098738 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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