1700980711 NPI number — THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION

Table of content: (NPI 1700980711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700980711 NPI number — THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MARY LANNING MEMORIAL 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:
1700980711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 N SAINT JOSEPH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68901-4497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-463-4521
Provider Business Mailing Address Fax Number:
402-461-5321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 N BURLINGTON AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68901-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-461-5161
Provider Business Practice Location Address Fax Number:
402-461-5091
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARBER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-461-5108

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  011004 , 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: 328 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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