Provider Demographics
NPI:1467520270
Name:NIOBRARA VALLEY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:NIOBRARA VALLEY HOSPITAL CORPORATION
Other - Org Name:NIOBRARA VALLEY HOSPITAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-569-2451
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:LYNCH
Mailing Address - State:NE
Mailing Address - Zip Code:68746-0118
Mailing Address - Country:US
Mailing Address - Phone:402-569-2451
Mailing Address - Fax:402-569-2474
Practice Address - Street 1:108 WEST EVANS ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NE
Practice Address - Zip Code:68777-0269
Practice Address - Country:US
Practice Address - Phone:402-589-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid