Provider Demographics
NPI:1346309929
Name:BOX BUTTE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:BOX BUTTE GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-762-6660
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0810
Mailing Address - Country:US
Mailing Address - Phone:308-762-6660
Mailing Address - Fax:308-762-1923
Practice Address - Street 1:2101 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4445
Practice Address - Country:US
Practice Address - Phone:308-762-6660
Practice Address - Fax:308-762-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE040001261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE81090OtherNEBR BCBS CERT DIAB ED
NE03495OtherNEBR BCBS PROF FEES
NE10025332400Medicaid
NE08610OtherNEBR BCBS CRNA
C01692OtherRR MEDICARE PROF FEES
NE=========15Medicaid
NE=========12Medicaid
NE10025332400Medicaid