Provider Demographics
NPI:1578571329
Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:COMMUNITY HEALTH SERVICES
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 1:1579 MIDLAND ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-9732
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:2006-08-04
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE581003251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE230OtherBCBS OF NEBRASKA
NE=========14Medicaid
NE=========14Medicaid