Provider Demographics
NPI:1558667048
Name:AVERA ST. ANTHONY'S HOSPITAL
Entity Type:Organization
Organization Name:AVERA ST. ANTHONY'S HOSPITAL
Other - Org Name:AVERA MEDICAL GROUP O'NEILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-2611
Mailing Address - Street 1:300 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1514
Mailing Address - Country:US
Mailing Address - Phone:402-336-2611
Mailing Address - Fax:402-336-5137
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1514
Practice Address - Country:US
Practice Address - Phone:402-336-2611
Practice Address - Fax:402-336-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty