Provider Demographics
NPI:1063498921
Name:THAYER COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:THAYER COUNTY MEMORIAL HOSPITAL
Other - Org Name:MILLIGAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-768-6041
Mailing Address - Street 1:120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-2019
Mailing Address - Country:US
Mailing Address - Phone:402-768-7203
Mailing Address - Fax:402-768-4669
Practice Address - Street 1:519 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILLIGAN
Practice Address - State:NE
Practice Address - Zip Code:68406
Practice Address - Country:US
Practice Address - Phone:402-629-4292
Practice Address - Fax:402-768-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========51Medicaid
NE=========51Medicaid