Provider Demographics
NPI:1306842604
Name:BRODSTONE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BRODSTONE MEMORIAL HOSPITAL
Other - Org Name:BRODSTONE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREG
Authorized Official - Middle Name:
Authorized Official - Last Name:VYZOUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-879-3281
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-0187
Mailing Address - Country:US
Mailing Address - Phone:402-879-3281
Mailing Address - Fax:402-879-3401
Practice Address - Street 1:520 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1225
Practice Address - Country:US
Practice Address - Phone:402-879-3281
Practice Address - Fax:402-879-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE570001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE281315Medicare Oscar/Certification