Provider Demographics
NPI:1407832355
Name:THAYER COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:THAYER COUNTY MEMORIAL HOSPITAL
Other - Org Name:CHESTER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-768-6041
Mailing Address - Street 1:120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-2019
Mailing Address - Country:US
Mailing Address - Phone:402-768-6041
Mailing Address - Fax:402-768-4669
Practice Address - Street 1:116 HURON ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NE
Practice Address - Zip Code:68327-6012
Practice Address - Country:US
Practice Address - Phone:402-324-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THAYER COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid
NE=========04Medicaid
NE283435Medicare Oscar/Certification