=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649716143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST HOLT MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2017
-----------------------------------------------------
Last Update Date | 12/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 W PEARL ST
-----------------------------------------------------
City | ATKINSON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68713-4958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-925-2651
-----------------------------------------------------
Fax | 402-925-2652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 W NEELY ST
-----------------------------------------------------
City | ATKINSON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68713-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-925-2811
-----------------------------------------------------
Fax | 402-925-2810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JEREMY BAUER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-925-1947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------