Provider Demographics
NPI:1588622187
Name:PHELPS MEMORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:PHELPS MEMORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-995-2211
Mailing Address - Street 1:1215 TIBBALS ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1255
Mailing Address - Country:US
Mailing Address - Phone:308-995-2211
Mailing Address - Fax:308-995-3223
Practice Address - Street 1:1215 TIBBALS ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1255
Practice Address - Country:US
Practice Address - Phone:308-995-2211
Practice Address - Fax:308-995-3223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHELPS MEMORIAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-03
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE610003275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2315819Medicaid
N002951OtherTRICARE HOSPITAL
IA0918672Medicaid
NE0409OtherBCBS SWINGBED
142918400OtherUS DEPT OF LABOR
MI30-4784016Medicaid
MI40-4784043Medicaid
OH2315819Medicaid
MI30-4784016Medicaid