Provider Demographics
NPI:1114933041
Name:PERKINS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PERKINS COUNTY HOSPITAL DISTRICT
Other - Org Name:PERKINS COUNTY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-352-7245
Mailing Address - Street 1:900 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3095
Mailing Address - Country:US
Mailing Address - Phone:308-352-7200
Mailing Address - Fax:308-352-7290
Practice Address - Street 1:900 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3095
Practice Address - Country:US
Practice Address - Phone:308-352-7200
Practice Address - Fax:308-352-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE600001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE28Z356Medicare Oscar/Certification