Healthcare Provider Details

I. General information

NPI: 1265502538
Provider Name (Legal Business Name): GOTHENBURG MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 20TH ST
GOTHENBURG NE
69138-1253
US

IV. Provider business mailing address

PO BOX 469
GOTHENBURG NE
69138-0469
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-3661
  • Fax: 307-537-3074
Mailing address:
  • Phone: 308-537-3661
  • Fax: 308-537-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number220002
License Number StateNE

VIII. Authorized Official

Name: ANDREW D KNUST
Title or Position: CEO
Credential:
Phone: 308-537-3661