Provider Demographics
NPI:1629035936
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE610003282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
142918400OtherUS DEPT OF LABOR
KS100099700AMedicaid
N002951OtherTRICARE HOSPITAL
NE00097OtherBCBS HOSPITAL
MI40-4784043Medicaid
MI40-4784043Medicaid
NE281362Medicare Oscar/Certification