1538264403 NPI number — WARREN MEMORIAL HOSPITAL

Table of content: PATRIC TIMOTHY KNECHT M.D. (NPI 1376078717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538264403 NPI number — WARREN MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN 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:
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:
1538264403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/07/2024
NPI Reactivation Date:
03/28/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 2ND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIEND
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68359-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-947-2541
Provider Business Mailing Address Fax Number:
402-947-2811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIEND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68359-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-947-2541
Provider Business Practice Location Address Fax Number:
402-947-2811
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEBRINK
Authorized Official First Name:
RON
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
402-947-2541

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54901 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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