Provider Demographics
NPI:1417015207
Name:MEMORIAL COMMUNITY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:MEMORIAL COMMUNITY HOSPITAL CORPORATION
Other - Org Name:FORT CALHOUN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNE/VP PATIENT CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-426-2182
Mailing Address - Street 1:4929 COUNTY ROAD P43
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5066
Mailing Address - Country:US
Mailing Address - Phone:402-468-4655
Mailing Address - Fax:402-468-4633
Practice Address - Street 1:4929 COUNTY ROAD P43
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5066
Practice Address - Country:US
Practice Address - Phone:402-468-4655
Practice Address - Fax:402-468-4633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL COMMUNITY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79001261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07683OtherBLUE CROSS BLUE SHIELD
NE07683OtherBLUE CROSS BLUE SHIELD