Provider Demographics
NPI:1033875380
Name:BRYAN HOSPITAL KEARNEY
Entity Type:Organization
Organization Name:BRYAN HOSPITAL KEARNEY
Other - Org Name:KEARNEY REGIONAL MEDICAL CENTER PLATTE VALLEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONEWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-481-1111
Mailing Address - Street 1:804 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2206
Mailing Address - Country:US
Mailing Address - Phone:308-455-3600
Mailing Address - Fax:308-455-3950
Practice Address - Street 1:816 22ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2226
Practice Address - Country:US
Practice Address - Phone:308-865-2263
Practice Address - Fax:308-865-2541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYAN HOSPITAL KEARNEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty