Healthcare Provider Details

I. General information

NPI: 1225658495
Provider Name (Legal Business Name): GRAND ISLAND REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 PRAIRIEVIEW ST
GRAND ISLAND NE
68803-4409
US

IV. Provider business mailing address

PO BOX 5225
GRAND ISLAND NE
68802-5225
US

V. Phone/Fax

Practice location:
  • Phone: 308-675-5000
  • Fax:
Mailing address:
  • Phone: 308-675-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW P WATERMAN
Title or Position: CEO
Credential:
Phone: 308-675-5000