Provider Demographics
NPI:1508979899
Name:CALLAWAY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CALLAWAY HOSPITAL DISTRICT
Other - Org Name:CALLAWAY HOSPITAL PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-836-2228
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:NE
Mailing Address - Zip Code:68825-0100
Mailing Address - Country:US
Mailing Address - Phone:308-836-2228
Mailing Address - Fax:308-836-2733
Practice Address - Street 1:211 E KIMBALL ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:NE
Practice Address - Zip Code:68825-2597
Practice Address - Country:US
Practice Address - Phone:308-836-2228
Practice Address - Fax:308-836-2733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALLAWAY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025136800Medicaid
NEDC3835OtherMEDICARE RAILROAD
NE04058OtherBCBS OF NEBRASKA
NE10025136700Medicaid
NE10025136800Medicaid
NE10025136700Medicaid