=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770669582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTELOPE MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 11/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 W 9TH ST
-----------------------------------------------------
City | NELIGH
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68756-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-887-4151
-----------------------------------------------------
Fax | 402-887-4092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 229
-----------------------------------------------------
City | NELIGH
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68756-0229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-887-4151
-----------------------------------------------------
Fax | 402-887-4092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DIANE M BRUGGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-887-4151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 020001
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 020001
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------