Provider Demographics
NPI:1366492472
Name:WEST HOLT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WEST HOLT MEMORIAL HOSPITAL
Other - Org Name:WEST HOLT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-925-1947
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NE
Mailing Address - Zip Code:68713-0458
Mailing Address - Country:US
Mailing Address - Phone:402-925-2631
Mailing Address - Fax:402-925-2914
Practice Address - Street 1:405 W PEARL ST
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NE
Practice Address - Zip Code:68713-4882
Practice Address - Country:US
Practice Address - Phone:402-925-2631
Practice Address - Fax:402-925-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid
0402720001Medicare NSC
NE283488Medicare Oscar/Certification
283488Medicare PIN