Healthcare Provider Details

I. General information

NPI: 1598878472
Provider Name (Legal Business Name): AVERA ST ANTHONYS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH 2ND ST
ONEILL NE
68763-1514
US

IV. Provider business mailing address

PO BOX 270
ONEILL NE
68763-0270
US

V. Phone/Fax

Practice location:
  • Phone: 402-336-2611
  • Fax: 402-336-5135
Mailing address:
  • Phone: 402-336-5154
  • Fax: 402-336-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number410002
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number410002
License Number StateNE

VIII. Authorized Official

Name: MR. TODD E. CONSBRUCK
Title or Position: CEO
Credential:
Phone: 402-336-2611