Provider Demographics
NPI:1235163486
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:COMMUNITY PHYSICIANS CLINIC WYMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-562-2311
Mailing Address - Street 1:100 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WYMORE
Mailing Address - State:NE
Mailing Address - Zip Code:68466-1704
Mailing Address - Country:US
Mailing Address - Phone:402-645-3733
Mailing Address - Fax:402-645-3127
Practice Address - Street 1:100 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WYMORE
Practice Address - State:NE
Practice Address - Zip Code:68466-1704
Practice Address - Country:US
Practice Address - Phone:402-645-3733
Practice Address - Fax:402-645-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========19Medicaid
NE=========22Medicaid
NE=========19Medicaid
KS016863Medicare Oscar/Certification