Healthcare Provider Details

I. General information

NPI: 1093792830
Provider Name (Legal Business Name): THAYER COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK AVE
HEBRON NE
68370-2019
US

IV. Provider business mailing address

120 PARK AVE
HEBRON NE
68370-2019
US

V. Phone/Fax

Practice location:
  • Phone: 402-768-6041
  • Fax: 402-768-4669
Mailing address:
  • Phone: 402-768-6041
  • Fax: 402-768-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number760001
License Number StateNE

VIII. Authorized Official

Name: BRIAN ROKUSEK
Title or Position: CEO
Credential:
Phone: 402-768-6041