1710142195 NPI number — ANTELOPE MEMORIAL HOSPITAL

Table of content: (NPI 1710142195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710142195 NPI number — ANTELOPE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTELOPE 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:
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:
1710142195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 W 9TH ST
Provider Second Line Business Mailing Address:
BOX 229
Provider Business Mailing Address City Name:
NELIGH
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68756-1114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-887-4151
Provider Business Mailing Address Fax Number:
402-887-4092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 WEST 9TH ST
Provider Second Line Business Practice Location Address:
BOX 229
Provider Business Practice Location Address City Name:
NELIGH
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68756-0229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-887-4151
Provider Business Practice Location Address Fax Number:
402-887-4092
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRUGGER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
402-887-4151

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  020001 , 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: 115 . 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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