Healthcare Provider Details

I. General information

NPI: 1548391709
Provider Name (Legal Business Name): MEMORIAL COMMUNITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N. 22ND ST
BLAIR NE
68008-1128
US

IV. Provider business mailing address

810 N. 22ND ST
BLAIR NE
68008-1128
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-2182
  • Fax: 402-426-1191
Mailing address:
  • Phone: 402-426-2182
  • Fax: 402-426-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number790001
License Number StateNE

VIII. Authorized Official

Name: AMY ZIMMER
Title or Position: CNE/VP PATIENT CARE SERVICES
Credential:
Phone: 402-426-2182