Provider Demographics
NPI:1326136847
Name:NIOBRARA VALLEY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:NIOBRARA VALLEY HOSPITAL CORPORATION
Other - Org Name:NIOBRARA VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-569-2451
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:LYNCH
Mailing Address - State:NE
Mailing Address - Zip Code:68746-0118
Mailing Address - Country:US
Mailing Address - Phone:402-569-2451
Mailing Address - Fax:402-569-2474
Practice Address - Street 1:401 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LYNCH
Practice Address - State:NE
Practice Address - Zip Code:68746-3013
Practice Address - Country:US
Practice Address - Phone:402-569-2451
Practice Address - Fax:402-569-2474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIOBRARA VALLEY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE050001275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28Z303Medicare Oscar/Certification