Healthcare Provider Details

I. General information

NPI: 1528016995
Provider Name (Legal Business Name): ST. MARY'S COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 GRUNDMAN BLVD
NEBRASKA CITY NE
68410-3323
US

IV. Provider business mailing address

1301 GRUNDMAN BLVD
NEBRASKA CITY NE
68410-3323
US

V. Phone/Fax

Practice location:
  • Phone: 402-873-3321
  • Fax: 402-873-9033
Mailing address:
  • Phone: 402-873-3321
  • Fax: 402-873-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberH000128
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH000128
License Number StateNE

VIII. Authorized Official

Name: EVERT KUIPER
Title or Position: CEO - CHI HEALTH
Credential:
Phone: 402-343-4420