Provider Demographics
NPI:1033277751
Name:CHASE COUNTY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:CHASE COUNTY COMMUNITY HOSPITAL
Other - Org Name:CHASE COUNTY PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CYBORON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-882-7111
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-0819
Mailing Address - Country:US
Mailing Address - Phone:308-882-7111
Mailing Address - Fax:308-882-7317
Practice Address - Street 1:600 W 12TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3131
Practice Address - Country:US
Practice Address - Phone:308-882-7111
Practice Address - Fax:308-882-7317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHASE COUNTY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE087582Medicare PIN