MEDICARE: THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1376935296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	715 N SAINT JOSEPH AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-4497
Country	:	US
Telephone Number	:	402-463-4521
Fax Number	:	402-461-5321

Provider Business Practice Location Address
First Line	:	425 N DIERS AVE
Second Line	:	STE 2A
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4910
Country	:	US
Telephone Number	:	308-398-0990
Fax Number	:	308-398-1711

Authorized Official
Title or Position	:	CEO
Name	:	MR. ERIC A. BARBER
Credential	:
Telephone Number	:	402-461-5108

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/20/2015

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