1194753889 NPI number — COMMUNITY HOSPITAL ASSOCIATION

Table of content: (NPI 1194753889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194753889 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:
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:
1194753889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2019
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:
MC COOK
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:
308-344-8303
Provider Business Mailing Address Fax Number:
308-344-8572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 E 11TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MC COOK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69001-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-344-8356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006

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: 251E00000X , with the licence number:  651001 , 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: 00530 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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