Provider Demographics
NPI:1083930507
Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:MLMH ER PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-461-5108
Mailing Address - Street 1:715 NORTH ST. JOSEPH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4497
Mailing Address - Country:US
Mailing Address - Phone:402-463-4521
Mailing Address - Fax:402-461-5321
Practice Address - Street 1:715 NORTH ST. JOSEPH AVENUE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4497
Practice Address - Country:US
Practice Address - Phone:402-463-4521
Practice Address - Fax:402-461-5321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-08
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1613Medicare PIN