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General NPI Number Information
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NPI Number | 1922802669
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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 | 04/02/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 5427 HIGHWAY 136
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City | DESHLER
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State | NE
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Zip | 68340-9845
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Country | US
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Telephone | 402-207-1132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | SUPERIOR
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State | NE
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Zip | 68978-0187
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Country | US
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Telephone | 402-879-3281
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Fax | 402-879-3401
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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 | 402-207-1516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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