1346468782 NPI number — CHEYENNE COUNTY HOSPITAL ASSOCIATION INC

Table of content: (NPI 1346468782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346468782 NPI number — CHEYENNE COUNTY HOSPITAL ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
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:
1346468782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 POLE CREEK XING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69162-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-254-5825
Provider Business Mailing Address Fax Number:
308-254-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
549 KELLER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69162-1775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-254-3314
Provider Business Practice Location Address Fax Number:
308-254-3415
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
UTLEY
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
308-254-5064

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  154002 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 154002 , 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)





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