Provider Demographics
NPI:1063470953
Name:NIOBRARA VALLEY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:NIOBRARA VALLEY HOSPITAL CORPORATION
Other - Org Name:NIOBRARA VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-569-2451
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:LYNCH
Mailing Address - State:NE
Mailing Address - Zip Code:68746-0118
Mailing Address - Country:US
Mailing Address - Phone:402-569-2451
Mailing Address - Fax:402-569-2474
Practice Address - Street 1:401 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LYNCH
Practice Address - State:NE
Practice Address - Zip Code:68746-3013
Practice Address - Country:US
Practice Address - Phone:402-569-2451
Practice Address - Fax:402-569-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363L00000X
NE050001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00137OtherBC BS IDENTIFICATION NUMB
NE=========00Medicaid
NE=========13Medicaid
NENA1569Medicare PIN
NE281303Medicare Oscar/Certification