Provider Demographics
NPI:1437281623
Name:MEMORIAL COMMUNITY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:MEMORIAL COMMUNITY HOSPITAL CORPORATION
Other - Org Name:COTTONWOOD 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 1:3519 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:TEKAMAH
Mailing Address - State:NE
Mailing Address - Zip Code:68061-5095
Mailing Address - Country:US
Mailing Address - Phone:402-374-1585
Mailing Address - Fax:402-374-1612
Practice Address - Street 1:3519 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:TEKAMAH
Practice Address - State:NE
Practice Address - Zip Code:68061-5095
Practice Address - Country:US
Practice Address - Phone:402-374-1585
Practice Address - Fax:402-374-1612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL COMMUNITY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07645OtherBLUE CROSS BLUE SHIELD
NE07645OtherBLUE CROSS BLUE SHIELD
NE07645OtherBLUE CROSS BLUE SHIELD