Healthcare Provider Details

I. General information

NPI: 1629035936
Provider Name (Legal Business Name): PHELPS MEMORIAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 TIBBALS ST
HOLDREGE NE
68949-1255
US

IV. Provider business mailing address

1215 TIBBALS ST
HOLDREGE NE
68949-1255
US

V. Phone/Fax

Practice location:
  • Phone: 308-995-2211
  • Fax: 308-995-3223
Mailing address:
  • Phone: 308-995-2211
  • Fax: 308-995-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number610003
License Number StateNE

VIII. Authorized Official

Name: MR. MARK D HARREL
Title or Position: CEO
Credential:
Phone: 308-995-2211