Healthcare Provider Details

I. General information

NPI: 1568501302
Provider Name (Legal Business Name): ANTELOPE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 9TH ST
NELIGH NE
68756-1114
US

IV. Provider business mailing address

PO BOX 109
NELIGH NE
68756-0109
US

V. Phone/Fax

Practice location:
  • Phone: 402-887-4151
  • Fax: 402-887-4092
Mailing address:
  • Phone: 402-887-5440
  • Fax: 402-887-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE M BRUGGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-887-4151