1164691531 NPI number — BOX BUTTE GENERAL HOSPITAL

Table of content: (NPI 1164691531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164691531 NPI number — BOX BUTTE GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOX BUTTE GENERAL 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:
6
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:
1164691531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69301-0810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-762-6660
Provider Business Mailing Address Fax Number:
308-762-1923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2091 BOX BUTTE AVE
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69301-4452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-762-7244
Provider Business Practice Location Address Fax Number:
308-762-6657
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GRIESS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
308-762-6660

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025651800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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