Provider Demographics
NPI:1326182494
Name:GORDON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GORDON MEMORIAL HOSPITAL
Other - Org Name:GORDON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-282-0401
Mailing Address - Street 1:300 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1123
Mailing Address - Country:US
Mailing Address - Phone:308-282-0401
Mailing Address - Fax:308-282-6191
Practice Address - Street 1:807 N ASH ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1132
Practice Address - Country:US
Practice Address - Phone:308-282-2200
Practice Address - Fax:308-282-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE730001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098738OtherMEDICARE PART B PROVIDER
NE098738Medicare PIN