Healthcare Provider Details

I. General information

NPI: 1376971036
Provider Name (Legal Business Name): PENDER COMMUNITY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 MAIN ST
BANCROFT NE
68004-3021
US

IV. Provider business mailing address

PO BOX 100
PENDER NE
68047-0100
US

V. Phone/Fax

Practice location:
  • Phone: 402-648-7606
  • Fax:
Mailing address:
  • Phone: 402-385-4012
  • Fax: 402-385-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA J GAMBLE
Title or Position: CEO
Credential:
Phone: 402-385-3083