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General NPI Number Information
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NPI Number | 1073590626
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Entity Type | Organization
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Legal Business Name | BRODSTONE MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/26/2005
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 525 E 11TH ST
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City | SUPERIOR
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State | NE
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Zip | 68978-1101
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Country | US
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Telephone | 402-879-4781
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Fax | 402-879-3365
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Provider Business Mailing Address
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Address Line | PO BOX 407
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City | SUPERIOR
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State | NE
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Zip | 68978-0407
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Country | US
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Telephone | 402-879-4781
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Fax | 402-879-3365
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Authorized Official
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Title or Position | CEO
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Name | TREG VYZOUREK
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Credential |
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Telephone | 402-879-3281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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