Provider Demographics
NPI:1497764559
Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:SYRACUSE AREA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-269-2011
Mailing Address - Street 1:PO BOX N
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0518
Mailing Address - Country:US
Mailing Address - Phone:402-269-2011
Mailing Address - Fax:402-269-7621
Practice Address - Street 1:2731 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-7880
Practice Address - Country:US
Practice Address - Phone:402-269-2011
Practice Address - Fax:402-269-7621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-07
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE580002275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE642OtherBCBS OF NEBRASKA
NE=========00Medicaid
NE=========00Medicaid