Healthcare Provider Details

I. General information

NPI: 1285677633
Provider Name (Legal Business Name): COZAD COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 12TH ST
COZAD NE
69130-1532
US

IV. Provider business mailing address

PO BOX 108
COZAD NE
69130-0108
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-2261
  • Fax: 308-784-4691
Mailing address:
  • Phone: 308-784-2261
  • Fax: 308-784-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number220001
License Number StateNE

VIII. Authorized Official

Name: ROBERT J DYER
Title or Position: CEO
Credential:
Phone: 308-784-2261