Healthcare Provider Details

I. General information

NPI: 1699746248
Provider Name (Legal Business Name): BRODSTONE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N C ST
EDGAR NE
68935-3194
US

IV. Provider business mailing address

PO BOX 407
SUPERIOR NE
68978-0407
US

V. Phone/Fax

Practice location:
  • Phone: 402-224-3344
  • Fax: 402-224-3346
Mailing address:
  • Phone: 402-879-4781
  • Fax: 402-879-3365

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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREG VYZOUREK
Title or Position: CEO
Credential:
Phone: 402-879-3281