Healthcare Provider Details

I. General information

NPI: 1508956467
Provider Name (Legal Business Name): FILLMORE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 F ST
GENEVA NE
68361-2229
US

IV. Provider business mailing address

PO BOX 193 1900 F STREET
GENEVA NE
68361-2229
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-3167
  • Fax: 402-759-3505
Mailing address:
  • Phone: 402-759-3167
  • Fax: 402-759-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19209
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19273
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23267
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28987
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25605
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number280001
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1324
License Number StateNE
# 8
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1228
License Number StateNE
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111821
License Number StateNE
# 10
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110466
License Number StateNE
# 11
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11612
License Number StateNE
# 12
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number111110
License Number StateNE
# 13
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number722
License Number StateNE

VIII. Authorized Official

Name: MRS. JEANNE L ACKLAND
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 402-759-3167