Healthcare Provider Details

I. General information

NPI: 1467520270
Provider Name (Legal Business Name): NIOBRARA VALLEY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/02/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WEST EVANS ST
SPENCER NE
68777-0269
US

IV. Provider business mailing address

PO BOX 118
LYNCH NE
68746-0118
US

V. Phone/Fax

Practice location:
  • Phone: 402-589-1580
  • Fax:
Mailing address:
  • Phone: 402-569-2451
  • Fax: 402-569-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNE

VIII. Authorized Official

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