Provider Demographics
NPI:1497816102
Name:BRYANLGH MEDICAL CENTER
Entity Type:Organization
Organization Name:BRYANLGH MEDICAL CENTER
Other - Org Name:BRYANLGH HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-481-1111
Mailing Address - Street 1:2300 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3704
Mailing Address - Country:US
Mailing Address - Phone:402-481-9999
Mailing Address - Fax:402-481-9990
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:TOWER A SUITE 400
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-481-9999
Practice Address - Fax:402-481-9990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYANLGH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE501002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE479OtherBCBS
NE479OtherBCBS
NE=========14Medicaid