1922166453 NPI number — MEMORIAL COMMUNITY HOSPITAL CORPORATION

Table of content: (NPI 1922166453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922166453 NPI number — MEMORIAL COMMUNITY HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL COMMUNITY HOSPITAL CORPORATION
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:
MCH PHYSICIANS
Provider Other Organization Name Type Code:
3
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:
1922166453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 N. 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIR
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68008-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-426-2182
Provider Business Mailing Address Fax Number:
402-426-1191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 N. 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIR
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68008-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-426-2182
Provider Business Practice Location Address Fax Number:
402-426-1191
Provider Enumeration Date:
12/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZIMMER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CNE/VP PATIENT CARE SERVICES
Authorized Official Telephone Number:
402-426-2182

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  79001 , 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: 01802 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025024000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".