Healthcare Provider Details

I. General information

NPI: 1063470953
Provider Name (Legal Business Name): NIOBRARA VALLEY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 5TH ST
LYNCH NE
68746-3013
US

IV. Provider business mailing address

PO BOX 118
LYNCH NE
68746-0118
US

V. Phone/Fax

Practice location:
  • Phone: 402-569-2451
  • Fax: 402-569-2474
Mailing address:
  • Phone: 402-569-2451
  • Fax: 402-569-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number050001
License Number StateNE

VIII. Authorized Official

Name: MR. KELLY E KALKOWSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-569-2451